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FIRST LINES 



PRACTICE of PHYSIC 

BY 

WILLIAM CULLEN, M.D. 

LATE PROFESSOR OF THE PRACTICE OF PHYSlC IN THE 
UNIVERSITY OF EDINBURGH, &c. &c. 

IN FOUR VOLUMES. 

. s t — . , „__ 

WITH PRACTICAL AND EXPLANATORY NOTES, 

BT JOHN ROtHERAM, 

M.D. F. R. &A. SS. EDIN. 
A NEW EDITION WITH IMPROVEMENTS. 

VOL. IV. 

EDINBURGH: 

Printed for Bell St Bradfute", and William Creech j 

and 

G. G. and J. Robinsons, and H. Murray, London. 

M Dec xcvi. 



.-/. 






v ' v ' 




CONTENTS. 



PART II. BOOK III. 

Page 

Se&. III. Of the Spafmodic /tffeflions in the 
Natural Functions ~ 9 

CHAP. VIII. 

Of the Pyrosis, or ivfrat is named in Scot~ 
land the Water-Brash - 9 



CHAP. IX. 




Of the Colic - • 


*7 


CHAP. X. 




Of the Cholera 


40 


, 


CHAP. 



#' 



iv CONTENDS. 



Page 



CHAP. XL 

Q/"Diarraoea or Looseness 51 

CHAP. XII. 
Of the Diabetes - - 8$ 

CHAP. XIII. 

Of the Hysteria, or the Hysteric 
Disease - - 98 

CHAP. XIV. 

Of Canine Madness and Hydro- 
phobia - - 116 

BOOK IV. 

Of VESANLE, or of the Disor- 
ders of the Intellectual 
Functions. - - 12© 

CHAP. 






kJJiilA 



CONTENTS. v 

Page 
CHAP. I. 
0/VESANl.as in general - no 



CHAP. II. 
0/*Mania or Madness 

CHAP. III. 



!S3 



Of Melancholy, and other forms of 
Infanity - - 178 



PART III. 



OF CACHEXIES 



19S 



BOOK I. 



Of EMACIATIONS 



203 
BOOK 



vi CONTENTS. 

BOOK II. 

Page 

Of INTUMESCENTLE, or General 
Swellings - - 231 

CHAP. I. 

Of Adipose Swellings - 233 

CHAP. II. 
Of Flatulent Swellings 242 

CHAP. III. 

Of Watery Swellings, or Drop- 
sies - - 265. 

Sedl. I. Of Anafarca - 293 

Sedt. II. Of the Hydrothorax, or Dropfy 
cf the Breajl ■ - - 326 

Sea. 



CONTEN T S. vii 

Page 

Seel:. II. Of Afcites, or Dropfy of the 
Lower Belly - 34« 

CHAP. IV. 

0/*General Swellings, arifingfrom 
an increased bulk of the whole 
fubjlance of Particular Parts. 350 

Of Rachitis, or Rickets - 351 

book nr. 

Of the IMPETIGINES, oe deprav- 
ed Habit, with Affections of 
the Skin. - - 378 

C H A P. I. 

0/"Scrophula, or the King's Evil 380 

CHAP, 



viii CONTENTS. 

Page 
C H A P. II. 

Of Siphylis, or the Venereal Dis- 
ease 304 

CHAP. III. 
O/" Scurvy - • '- 441 

CHAP. IV. 
Of Jaundice - - 463 , 



FIRST LINES 



OF THE 



PRACTICE of PHYSIC. 

PART II. 

BOOK III. SECT. Ill, 

Of the SPASMODIC AFFECTIONS 
In the NATURAL FUNCTIONS. 



CHAP. VIII. 

Of the Pyrosis, or what is named 
in Scotland the Water-Brash. 

1427. ' I 'HE parnful fenfations referred 

■*- to the ftomach, and which 

are probably occafioned by real affections 

Vol. IV. B . of 



io PRACTICE 

of this organ, are of different kinds. Pro- 
bably they proceed from affections of dif- 
ferent natures, andfhould therefore be dis- 
tinguished by different appellations ; but 
I muft own that the utmoft precifion in 
this matter will be difficult. In my ef- 
fay towards a methodical Nofology, I 
have, however, attempted it. For thofe 
pains that are either acute or pungent, or 
accompanied with a fenfe of diftention, 
or with a fenfe of conftricUon, if they are 
at the fame time not attended with any 
fenfe of acrimony or heat, I employ the 
appellation of Gaftrodynia. To exprefs 
thofe painful or uneafy fenfations which 
feem to arife from a fenfe of acrimony 
irritating the part, or from fuch a fenfe 
of heat as the application of acrids, whe- 
ther externally or internally applied, of- 
ten gives, I employ the terms of Cardial- 
gia ; and by this I particularly mean to 
denote thofe v feelings which are exprefled 

by 



O F P H Y S I C. n 

by the term Heart-burn in the Englifh 
language. I think the term Soda has 
been commonly employed by practical 
writers, to exprefs an affection attended 
with feelings of the latter kind. 

1428. Befide the pains denoted by the 
terms Gaftrodynia, Periadynia, Cardial- 
gia, and Soda, there is, I think, another 
painful fenfation different from all of 
thefe, which is named by Mr Sauvages 
Pyrofis Suecica ; and his account of it is 
taken from Linnaeus, who names it Car- 
dialgia Sputatoria. Under the title of Py- 
rofis Mr Sauvages has formed a genus, of 
of wl}ich the whole of the fpecies, except 
the eighth, which he gives under the 
title of Pyrofis Suecica, are all of them 
fpecies of the Gaftrodynia, or of the Car- 
dialgia ; and if there is a genus to be 
formed under the title of Pyrofis, it can 
in my opinion comprehend only the fpe- 
B 2 cies 



12 PRACTICE 

cies I have mentioned. In this cafe, in- 
deed, I own that the term is not very 
proper; but my averfion to introduce 
new names has made me continue to em- 
ploy the term of Mr Sauvages. 

1429. The Gaftrodynia and Cardialgia 
I judge to be for the mofl part fympto- 
matic affections ; and therefore have giv- 
en them no place in this work : but the 

\Pyrofis, as an idiopathic difeafe, and ne- 
ver before treated of in any fyftem, I 
propofe to treat of here. 

1430. It is a difeafe frequent among; 
people in lower life ; but occurs alfo, 
though more rarely, in , people of better 
condition. Though frequent in Scotland, 
it is by no means fo frequent as Linnasus 
reports it to be in Lapland. It. appears 
mod commonly in perfons under middle 
age, but feldom in any perfons before the 

age 






O F P H Y S I C. 13 

age of puberty. When it has once taken 
place, it is ready to recur occafionally 
a long time after ; but it feldom appears 
in perfons confiderably advanced in life. 
It affects both fexes, but more frequently 
the female. It fometimes attacks preg- 
nant women, and fome women only when 
they are in that condition. Of other wo- 
men, it more frequently affects the un- 
married ; and of the married, mdft fre- 
quently the barren. I have had many 
inftances of its occurring in women la- 
bouring under a fluor albus. 

1 43 1. The fits of this difeafe ufually 
come on in the morning and forenoon, 
when the ftomach is empty. The firit 
fymptom of it is a pain at the pit of the 
ftomach, witfy a fenfe of conftriction, as 
if the ftomach was drawn towards the 
back ; the pain is increafed by railing the 
body into an erect pofture, and therefore 
B 3 - the 



i 4 PRACTICE 

the body is bended forward. This pain 
is often very fevere ; and, after continu- 
ing for fome time, it brings on an eruc- 
tation of a thin watery fluid in conn- 
derable quantity. This fluid has fome- 
times an acid tafte, but is very often ab- 
folutely infipid. The eructation is for 
fome time frequently repeated ; and does 
not immediately give relief to the pain 
which preceded it, but does fo at length, 
and puts an end to the fit. 

1432. The fits of this difeafe common- 
ly come on without any evident excit- 
ing caufe, and I have not found it ftea- 
dily connected with any particular diet. 
It attacks perfons ufing animal food, but 
I think more frequently thofe living on 
milk and farinacea. It feems often to be 
excited by cold applied, to the lower ex- 
tremities, and is readily excited by any 
considerable emotion of mind. It is of- 
1 ten 



O F P H Y S I G. 15 

ten without any fymptoms of dyfpep- 
fia. 



1433. The nature of this affection is 
not very obvious j but I think it may be 
explained in this manner : It feems to be- 
gin by a fpafm of the mufcular fibres of 
the ftomach ; which is afterwards, in a 
certain manner, communicated to the 
blood-vefTels and exhalants, fo as to in- 
creafe the impetus of the fluids in thefe 
vefTels, while a conflriclion takes place on 
their extremities. While therefore the 
increafed impetus determines a greater 
quantity than ufual of fluids into thefe 
vefTels, the conftridtion upon their extre- 
mities allows only the pure watery parts 
to be poured out, analogous, as I judge, 
in every refpect, to what happens in the 
diabetes hyftericus. 

1434. The practice in this difeafe is as 

B 4 difficult 



16 PRACTICE 

difficult as the theory. The paroxyfm is 
only to be certainly relieved by opium. 
Other antifpafmodics, as vitriolic ether 
and volatile alkali, are fometimes of fervice, 
but not conftantly fo. Although opium" 
and other antifpafmodics relieve the fits, 
they have no effect in preventing their 
recurrence. For this purpofe, the whole 
of the remedies of dyfpepfia have been 
employed without fuccefs. Of the ufe 
of the nux vomica, mentioned as a reme- 
dy by Linnaeus, I have had no experience. 



CHAP. 



O F P H Y S I C. 17 



CHAP. IX. 



OF THE 



COLIC. 



1435. r T^ HE principal fymptom of this 
difeafe is a pain felt in the 
lower belly. It is feldom fixed and 
pungent in one part, but is a painful 
diftention in fome meafure fpreading 
over the whole of the belly ; and par- 
ticularly 



18 PRACTICE 

ticularly with a fenfe of twifting or 
wringing round the navel. At the 
fame time, with this pain, the navel 
and teguments of the belly are frequently 
drawn inwards, and often the mufcles of 
the belly are fpafmodically contracted, and 
this in feparate portions, giving the ap- 
pearance of a bag full of round balls. - 

1436. Such pains, in a certain degree, 
fometimes occur in cafes of diarrhoea and 
cholera ; but thefe are lefs violent and 
more tranikory, and are named Gripings. 
It is only when more violent and perma- 
nent, and attended with coftivenefs, that 
they conftitute colic. This is alfo com- 
monly attended with vomiting, which in 
many cafes is frequently repeated, efpeci- 
ally when any thing is taken down into 
the ftomach ; and in fuch vomitings, not 
only the contents of the ftomach are 
thrown up, but alfo the contents of the 

duodenum, 



OF PHYSIC. 19 

duodenum, and therefore frequently a 
quantity of bile. 

1437. In fome cafes of colic, the peri- 
flaltic motion is inverted through the 
whole length of the alimentary canal, in 
fuch a manner that the contents of the 
great guts, and therefore ftercoraceous 
matter, is thrown up by vomiting; and 
the fame inverfion appears dill more clear- 
ly from this, that what is thrown into 
the rectum - by glyfter is again thrown out 
by the mouth. In thefe circumflances of 
inverfion the difeafe has been named ileus, 
or, the Iliac Pamon ; and this has been 
fuppofed to be a peculiar difeafe diftincl: 
form colic ; but to me it appears that the 
two difeafes are owing to the fame pro- 
ximate caufe, and have the fame fymptoms, 
only in a different degree. 

1438. The colic is often without any 

pyrexia 



lo PRACTICE 

pyrexia attended it. Sometimes, how- 
ever, an inflammation comes upon the 
part of the inteftine efpecially afFedled ; 
and this inflammation aggravates all the 
fymptoms of the difeafe, being probably 
what brings on the mod confiderable in- 
verfion of the periflaltic motion ; and, as 
the ftercoraceous vomiting is what efpe- 
cially diftinguifhes the ileus, this has been 
confidered as always depending on an in- 
flammation of the inteflines. However, I 
can affirm, that as there are inflammations 
of the. inteflines without ftercoraceous vo- 
miting, fo I have feen inftances of ftercor- 
aceous vomiting without inflammation ; 
and there is therefore no ground for dif- 
tinguifhing ileus from colic, but as a higher 
degree of the fame afFec"lion. 

1439. The fymptoms of the colic, and 
the difTections of bodies dead of this dif- 
eafe, fliow very clearly, that it depends 

upon 



O F P H Y S I C. 21 

upon a fpafmodic conftriclion of a part of 
the inteftines ; and that this therefore is 
to be confidered as the proximate caufe of 
the difeafe. In fome of the difTeifUons of 
perfons dead of this' difeafe, an intro-fuf- 
ception has been remarked to have hap- 
pened ; but whether this be constantly 
the cafe in all the appearances of ileus, is 
not certainly determined. 

1440. The colic has commonly been 
confidered as being of different fpecies, 
but I cannot follow the writers on this 
fubject in the diftinclions they have efta- 
bliihed. So far, however, as a difference 
of the remote caufe conftitutes a difference 
of fpecies a diflinclion may perhaps be 
admitted ; and accordingly in my Nofology 
I have marked feven different fpecies : 
but I am well perfuaded, that in all thefe 
different fpecies the proximate caufe is the 
fame, that is, a fpafmodic conftriclion of a 

part 



22 PRACTICE 

part of the inteftines ; and confequently, 
that in all thefe cafes the indication of cure 
is the fame, that is, to remove the conftric- 
tion mentioned. Even in the feveral fpe- 
cies named St er cor ea> (Hallo/a, axi&Calculofa, 
in which the difeafe depends upon an ob- 
ftruclion of the inteftine, I am perfuaded 
that thefe obftrudtions do not produce the, 
fymptoms of colic, excepting in fo far as 
they produce fpafmodic conftrictions of 
the inteftines ; and therefore that the 
means of cure in thefe cafes, fo far as they 
admit of cure, muft be obtained by the 
fame means which the general indication 
above mentioned fuggefts. 

1 44 1. The cure, then, of the colic uni- 
verfally, is to be obtained by removing the 
fpafmodic conftrictions of the inteftines ; 
and the remedies fuited to this' purpofe 
may be referred to three general heads. 

i. The 



O F P H Y S I C. 2$ 

1. The taking off the fpafm by various 
antifpafmodic powers. 

2. The exciting the action of the intef- 
tines by purgatives. 

3. The employing mechanical dilata- 
tion. 

1442. Before entering upon a particu- 
lar account of thefe remedies, it will be 
proper to obferve, that in all cafes of 
violent colic, it is advifable to praclife 
blood-letting ; both as it may be ufeful 
in obviating the inflammation which is 
commonly to be apprehended, and even as 
it may be a means of relaxing the fpafm "of 
the inteftine. This remedy may perhaps 
be improper in perfons of a weak and lax 
habit, but in all perfons of tolerable vi- 
gour it will be a fafe remedy ; and in all 
eafes where there is the lead fufpicion of 

an 



24 PRACTICE 

an inflammation actually coming on, «; 
will be abfolutely neceflfary. Nay, it will 
be even proper to repeat it perhaps feveral 
times, if, with a full and hard pulfe, the 
appearance of the blood drawn, and the 
relief obtained by the firft bleeding, Ihall 
authorife fuch repetition.* 

1443. The antifpafmodic powers that 
may be employed, are, the application of 
heat in a dry or humid form, the applica* 
tion of blifters, the ufe of opium, and the 
ufe of mild oils. 

The application of heat, in a dry form, 
has been employed by applying to the 
belly of the patient a living animal, or 
bladders filled with warm water, or bags 
of fubftances which long retain their heat ; 
and all thefe have fometimes been applied 
with fuccefs ; but none of them feem to 
3 me 



OF PHYSIC. 25 

me fo powerful as the application of heat 
in a humid form. 



This may be employed either by the 
immerfion of a great part of the body in 
warm water, or by fomenting the belly 
with cloths wrung out of hot water. The 
immerfion has advantages from the appli- 
cation of it to a greater part of the body, 
and particularly to the lower extremities : 
but immerfion cannot always be conve- 
niently praclifed, and fomentation may 
have the advantage of being longer conti- 
nued ; and it may have nearly all the be- 
nefit of immerfion, if it be at the fame time 
applied both to the belly and to the lower 
extremities. 

1444. From confidering that the tegu- 
ments of the lower belly have fuch a con- 
nection with the inteftines, as at the fame 
time to be affefted with fpafmodic con- 

Vol, IV. C traclion, 



26 PRACTICE 

traciion, we perceive that blifters applied 
to the belly may have the effecl of taking 
off the fpafms both from the mufcles 
of the belly and from the inteftines ; and 
accordingly bliftering has often been em- 
ployed in the colic with advantage. Ana- 
logous to this, rubefacients applied to the 
beHy have been frequently found ufeful. 

1445. The ufe of opium in colic may 
feem to be an ambiguous remedy. Very 
certainly it may for fome time relieve the 
pain, which is often fo violent and urgent, 
that it is difficult to abftain from the ufe 
of luch a remedy. At the fame time, the 
ufe of opium retards or fufpends the perifc 
taltic motion fo much, as to allow the in- 
teftines to fall into conftrictions ; and may 
therefore, while it .relieves the pain, render 
the caufe of 'the difeafe more obftinate. 
On this account, and further as opium pre- 
vents the operation of purgatives fo often 
* necefFary 



OF PHYSIC, ay 

neceffary in this difeafe, many practition- 
ers are averfe to the ufe of it, and fome en- 
tirely reject the ufe of it as hurtful. There 
are, however, others, who think they can 
employ opium in this difeafe with much 
advantage. 

In all cafes where the colic comes on . 
without any previous' coftivenefs, and ari- 
fes from cold, from pafllons of the mind, 
or other caufes which operate efpecially on 
the nervous fyftem, opium proves a fafe 
and certain remedy ; but in cafes which 
have been preceded by long Coftivenefs, 
or where the colic, though not preceded 
by coftivenefs, has however continued for 
lbme days without a ftool, fo that a ftag- 
nation of faeces in the colon is to be fuf- 
peeled, the ufe of opium is of doubtful 
efFect. In fuch cafes, unlefs a ftool has 
been firft procured by medicine, opium 
cannot be employed but with fome hazard 
C 2 of 



28. PRACTICE 

of. aggravating the difeafe. However, even 
in thofe circumflances of coftivenefs, when, 
without inflammation, the violence of the 
jpafm is to be fufpecled, when vomiting 
prevents the exhibition of purgatives, and 
when with all this the pain is extremely 
urgent, opium is to be employed, not only 
as an anodyne, but alfo as an antifpafmo- 
dic, necefTary to favour the operation of 
purgatives; and may be fo employed, 
w r hen, either at the fame time with the o- 
piate, or not long after it, a purgative can 
be exhibited. 

Is the hyofcyamus, as often fhowing, 
along with its narcotics, a purgative quali- 
ty, better fuited to this difeafe than opium ? 

1446. It is feemingly on good grounds 
that feveral practitioners have recommends 
ed the large ufe of mild oils in this dif- 
eafe, both as. antifpafmodics and as laxa- 
2 - " tives; 



OF PHYSIC. 29 

tives ; and where the palate and ftomacli 
could admit them, I have found them very 
ufeful. But as there are few Scottifh fto- 
machs that can admit a large ufe of oils, 
I have had few opportunities of employ- 
ing them. 

1447. The fecond fet of remedies ad- 
apted to the cure of colic, are purgatives ; 
which, by exciting the aclion of the in- 
terlines, either above or below the ob- 
ftructed place, may remove the conftric- 
tion ? and therefore thefe purgatives may 
be given either by the mouth, or thrown 
by glyfter into the anus. As the difeafe is- 
often feated in the great guts ; as glyfters, 
by having a more fudden operation, may 
give more immediate relief; and as pur- 
gatives given by the mouth are ready to 
be rejected by vomiting; fo it is common, 
and indeed proper, to attempt curing the 
-colic in the firft place by glyfters. Thefe 
C 3 may 



3 o PRACTICE 

may at firft be of the mildeft kind, con- 
fiding of a large bulk of water, with fome 
quantity of mild oil ; and fuch are fome- 
times fufBciently efficacious: however, 
they are not always fo ; and it is commonly 
neceffary to render them more powerfully 
ftimulant by the addition of neutral falts, of 
which the moft powerful is the common 
or marine fait. If thefe faline glyfters, as 
fometimes happens, are rendered again too 
quickly, and on this account or otherwife are 
found ineffectual, it may be proper, inftead 
of thefe falts, to add to the glyfters an in- 
fufion of fenna, or of fome other purga- 
tive that can be extracted by water. The 
antimonial wine * may be fometimes em- 
ployed in glyfters with advantage. Hard- 

* Tartar Emeticf is furer than the antimonial v.'ine;. 
but it is a very violent remedy, and ought to be ufecl 
with caution even in glyfters. Five or fix grains is the 
yfual quantity given ia glyfters. 



O F P H Y S I C. si 

ly any glyfters are more effectual than 
thofe made of turpentine * properly prepa- 
red. When all other injections are found 
ineffectual, recourfe is to be had to the 
injection of tobacco- fmoke : and, when 
even this fails, recourfe is to be had to the 
mechanical dilatation to be mentioned here- 
after. 

C 4 1448. As 

* The proper manner of preparing turpentine 
glyfters is as follows : 

R. Tereb. Venet, $in. 
Vitel. Ov. No. ii. 
Tere in mortar, marmoreo donee penitus fol- 

vetur Terebinthina ; dein adde gr^datim, 
Aq. font, frigid, zij. 
Huic affunde 
Aq. font, tepid, lb. L 
M. f. Enema, ftatim injiciend. 

If the turpentine does not diflolve fufficiently with, 
the yolks of two egg3, a third may be added. 



22 P R A C T I C E 

1448. As glyfters often fail altogether 
in relieving this difeafe, and as even 
when they give fome relief they are often 
imperfect in producing a complete cure; 
fo it is generally proper, and often necef- 
fary, to attempt a more entire and certain 
cure by purgatives given by the mouth. 
The more powerful of thefe, or, as they 
are called, the Draflic Purgatives, may 
be fometimes neceffary ; but. their ufe is 
to be avoided, both beqaufe they are apt 
to be rejected by vomiting, and becaufe 
when they do not fucceed in removing 
the obftrudUon they are ready to induce 
an inflammation. Upon this account it 
is ufual, and indeed proper, at lead in the 
firft place, to employ the milder and lefs 
inflammatory purgatives. None have fuc- 
ceeded with me better than the cryflals 
of tartar *, becaufe this medicine may 

be 

* Cryftals of tartar may be, given in dofes of two 

drachms 



O F P H Y S I C. 33 

be given in fmall but repeated dofes to 
a confiderable quantity ; and under this 
management it is the purgative lead ready- 
to be rejected by vomiting, and much, 
lefs fo than the other neutral falts. If a 
ftronger purgative be required, jalap f, 

properly 

■drachms each, repeated every two hours of oftener. 
The chief objection againft the ufe of this fait is its dif- 
ficult folution in water, and therefore many practi- 
tioners prefer the foluble tartar, or the Rochel fait. 

t The Pulvis Jalap, comp. of the Edinburgh phar- 
macopoeia anfwers in general very well ; but, the fol- 
lowing formula is lefs liable to be rejected by the vo- 
miting which fo frequently accompanies this difeafe. 

R. Refin. Jalap, gr. xij. 

Amygdal. dulc. decorticat. No. vi. 

Sacch. alb. 31. 

Tere in mortario marmoreo, et adde gra- 

datim, 
Aq. Ginnamom. fimpl. 3*i. 
M. f. hauft. 

Half 



34 PRACTICE 

properly prepared, is lefs offenfive to the 
palate, and fits better upon the ftomach, 
than mod other powerful purgatives. On 
many occafions of colic, nothing is a more 
effeduar purgative than a large dofe of 
calomel*. Some praditioners have at- 
tempted to remove the obftrudion of the 
inteftines by antimonial emetics f exhi- 
bited in fmall dofes repeated at proper in- 
tervals ; and when thefe dofes are not en- 
tirely 

Half of this potion may be given at once, and the o- 
ther half an hour afterward. 

* This is French practice, but it is dangerous. It 
has however been ferviceable in many cafes, when giv- 
en in dofes of ia or 15 grains, or even a fcruple, when 
other purgatives have failed. 

t As the ftonrach, as was before obferved, is very 
irritable in this difeafe, the practitioner will find confi- 
derable difficulty in managing antimonials. It is bet- 
ter to avoid them altogether, for they may do much 
mifchief. 



OF PHYSIC. 35 

tirely rejected by vomiting, they often 
prove effectual purgatives. 

When every purgative has failed, the 
action of the interlines has been effectually 
excited by throwing cold water on the 
lower extremities. 

1449. The third means of overcoming 
the fpafm of the inteftines in this difeafe, 
is by employing a mechanical dilatation ; 
and it has been frequently fuppofed that 
quickfilver, given in large quantity, might 
operate in this manner. I have not, how- 
ever, found it fuccefsful ; and the theory 
of it is with me very doubtful. Some au- 
thors have mentioned the ufe of gold and 
filver pills, or balls, fwallowed down ; but ( 
I have no experience of fuch practices, and 
I cannot fuppofe them a probable means 
of relief. 

1450. Another 



3 6 PRACTICE 

1450. Another means of mechanical di- 
latation, and a^more probable meafure, is 
by injecting a large quantity of warm 
water by a proper fyringe, which may 
throw it with fome force, and in a con- 
tinued ftream, into the reclum. Both 
from the experiments reported by the late 
Mr De Haen, and from thofe I myfelf 
have had occafion to make, I judge this 
remedy to be one of the moft powerful 
and effectual*. 

1 45 1. I have now mentioned all the 
feveral means that may be employed for 
the cure of the colic, confidered as a ge- 
nus j 

' * It is to be thrown up, by means of a large fyringe„ 
in fuch quantities, that the patient begins to feel a fenfe 
ef uneafinefs from the great diftention which it occa- 
fions. Some patients have borne two gallons to be in- 
, jefted, and the cafes were attended with the defired fuc- 
t*efi. 

The 



OF PHYSIC. 37 

nus ; but before I quit this fubject, it may- 
be expected that I mould take notice of 
fome of the fpecies which may feem to re- 
quire a particular confideration. In this 
view it may be expected that I mould efpe- 
cially take notice of that fpecies named the 
Colic of Poitou, and particularly known 
in England by the name of the Devonftiire 
Colic. 

1452. This fpecies of the difeafe is cer- 
tainly a peculiar one, both in refpect of* 
its caufe and its effects ; but, as to the 
iirft, it has been lately fo much the fub- 
ject of' invefligation, and is fb well as- 
certained by the learned phyficians, Sir 

George 

The cafes in which thefe large injections are moil 
ufeful, -are thofe in which hardened faeces are accumu- 
lated in the colon. The warm water anfwers two in- 
tentions, viz. dilating the pafiage, and foftening the 
f*eces. 



3 & PRACTICE 

George Baker and Dr Hardy, that it is 
unnecefTary for me to fay any thing of 
it here. 

With refpecl to the cure of it*, fo far 
as it appears in the form of a colic, my 
want of experience concerning it does not 
allow me to fpeak with any confidence on 
the fubjectj but, fo far as I can learn 

from 



* In the early ftages of this difeafe> the belly is to be 
kept open by the mildeft laxatives, and a milk diet ftri*£t- 
ly ufed. The following formula anfwers extremely 
well ; 

R. Mannse, 

01. Olivar. aa ji. 
M. L Linftus. 

This quantity is a proper dofe, and it may be repeat- 
ed every day with thirty or forty drops of laudanum at 
bed-time. If the fymptoms, however, do not abate, 
we may at the fame time give large emollient glyf. 
ters. 



OF PHYSIC. 39 

from others, it appears to me, that it is to 
be. treated by all the feveral means that 
I have propofed above for the cure of colic 
in general. 

How far the peculiar effeds of this dif- 
eafe are to be certainly forefeen and obvi- 
ated, I have not properly learned; amd 
I muft leave the matter to be determined 
by thofe who have had fufficient experi- 
ence in it. 



CHAP. 



4 o 



PRACTICE 



CHAP. X. 



OF THE. 



CHOLERA. 



1453. TN this difeafe, a vomiting and 
A purging concurring together, 
or frequently alternating with one ano- 
ther, are the chief fymptoms. The mat- 
ter 



F P H Y S I C. 4 t 

ter rejected both upwards and downwards 
appears manifestly to confift chiefly of 
bile. 

1454. From this laft circumftance I 
conclude, that the difeafe depends upon 
an increafed fecretion of bile, and its co- 
pious effufion into the alimentary canal ; 
and, as in this it irritates and excites the 
motions above-mentioned, I infer that the 
bile thus effufed in larger quantity is at 
the fame time alfo of a more acrid quali* 
ty. This appears likewife from the vio- 
lent and very painful gripings that attend 
the difeafe, and which we can impute on- 
ly to the • violent fpafmodic contractions 
of the inteftines that take place here* 
', Thefe fpafms are commonly communica- 
ted to the abdominal mufcles, and very fre- 
quently to thofe of the extremities* 

Vol. IV. D 1455. In 



4 2 PRACTICE 

1455. In the manner now defcribed, 
the dtieafe frequently proceeds with great 
violence till the ftrength of the patient 
is greatly, and often fuddenly, weak- 
ened ; while a coldnefs of the extremi- 
ties, cold fvveats, and faintings, coming 
on, an end is put to the patient's life, fome- 
times in the courfe of one day. In other 
cafes the difeafe is lefs violent, continues 
for a day or two, and then ceafes by de- 
grees ; though fuch recoveries feldom hap- 
pen without the afMance of remedies'. 

■ 

1456. The attacks of this difeafe are 

feldom accompanied with any fymptoms 
of pyrexia ; and though, during the courfe 
of it, both the pulfe and refpiration are 
hurried and irregular r yet thefe fymp- 
toms are generally fo entirely removed 
by the remedies that quiet the fpafmo- 
dic affections peculiar to the difeafe, as 
to leave no ground for fuppofing that it 

had 



O F P H Y S I C. 43 

had been accompanied by any proper py- 



rexia. 



1457. This is a difeafe attending a ve- 
ry warm Hate of the air ; and in very 
warm climates, it may perhaps appear at 
any time of the year ; but even in fuch. 
climates it is moft frequent during their 
warmed feafons ; and in temperate cli- 
mates, it appears only in the warm fea- 
fons. Dr Sydenham confidered the ap- 
pearances of this difeafe in England to be 
confined to the month of Auguft ; but he 
himfelf obferved it to appear fometimes 
towards the end of fummer, when the 
feafon was unufually warm j and that, in 
proportion to the heat, the violence of the 
difeafe was greater. Others have obferv- 
ed that it appeared more early in fummer, 
and always fooner or later, according as 
the great heats fooner or later fet in. 

B 2 J 458. From 



44 PRACTICE 

1458. From all thefe circumftances, it 
is, I think, very evident that this difeafe 
is the effedl of a warm atmofphere, pro- 
ducing fome change in the ftate of the 
bile in the human body : and the change 
may confift, either in the matter of the 
bile being rendered more acrid, and there- 
by fitted to excite a more copious fecre- 
tion ; or, in the fame matter, its being 
prepared to pafs over in larger quantity 
than ufual. 

1459. It has been remarked, that in 
warm climates and feafons, after extreme- 
ly hot and dry weather, a fall of rain cool- 
ing the atmofphere feems efpecially to 
bring on this difeafe ; and it is very pro- 
bable that an obftrucled perfpiration may 
have alfo a fhare in this, though it is alfo 
certain that the difeafe does appear when 
no change in the temperature of the air, 

nor 



F PH Y S I C. 45 

nor any application of cold, has been ob- 
ferved. 



1460. It is poflible, that, in fome cafes, 
the heat of the feafon may give only a pre- 
difpofition, and that the difeafe may be 
excited by certain ingefta or other caufe's ; 
but it is equally certain, that the difeafe 
has occurred without any previous change 
or error, either in diet, or in the manner of 
life, that could be obferved. 

1 46 1. The Nofologifts have conftituted 
a Genus under the title of Cholera, and 
under this have arranged as a fpecies 
every affection in which a vomiting and 
purging of any kind happened to concur. 
In many of thefe fpecies, however, the 
matter evacuated is not bilious ; nor does 
the evacuation proceed from any caufe in 
the ftate of the atmofphere. Further, in 
many of thefe fpecies alfo, the vomiting 

D 3 which 



46 PRACTICE 

which occurs is not an effential, but merely 
an accidental, fymptom from the particu- 
lar violence of the difeafe. The appella- 
tion of Cholera therefore fhould, in my 
opinion, be confined to the difeafe I have 
defcribed above ; which, by its peculiar 
caufe, and perhaps alfo by its fymptoms, 
is very^difFerent from all the other fpecies 
that have been aflbciated with it. I be- 
lieve that all the other fpecies arranged 
under the title of Cholera by Sauvages or 
Sagar, may be properly enough referred to 
the genus of Diarrhoea ; which we are to 
treat of in the next chapter. 

The diitinclion I have endeavoured to 
eflablifh between the proper Cholera, and 
the other difeafes that have fometimes 
got the fame appellation, will, as I judge, 
fuperfede the queftion, Whether the Cho- 
lera, in temperate climates, happens at 

' any 



O F P H Y S I C. 47 

any other feafon than that above align- 
ed? 



1462. In the cafe of a genuine cholera, 

the cure of it has been long eftablifhed by 

experience. 

1 

In the beginning of the difeafe, the 
evacuation of the redundant bile is to be 
favoured by the plentiful exhibition of 
mild diluents *, both riven by the mouth, . 
and injected by the anus ; and all evacu- 
ant medicines, employed in either way, 
are not only fuperfluous, but commonly 
hurtful. 

1463. When the redundant bile appears 

D 4 to 

* Thin rice-gruel is as proper a mild diluent as any 
we caq ufe ; as is alfo water in which a cruft of bread is 
boiled. A very fmall quantity of port wine may be 
added to thefe diluents if the pulfe be fmall or weak. 



48 PRACTICE 

to be fufficiently waflied out, and even 
before that, if the fpafmodic affections of 
the alimentary canal become very vio- 
lent, and are communicated in a confide- 
rable degree to other parts of the body, 
or when a dangerous debility feems to be 
induced, the irritation is N to be immedi- 
ately obviated by opiates in fufficiently 
large dofes, but in fmall bulk, and given 
either by the mouth or by glyfter *. 

1464. Though 



* A pill confiding of a grain of opium may be given 
every two hours, and if it does not relieve the fymptoms 
after the third or fourth repetition, we may injefl; the 
following glyfter : 

R. Decoa. Hord. ?x. 
Tinft. Opii, 3 ii. 
M. f. Enema. 

This glyfter may be repeated twice, or thrice if there, 
be occalion. 



OF PHYSIC. 



49 



1464. Though the patient be in this 
manner relieved, it frequently happens, 
that when the operation of the opium is 
over, the difeafe fhows a tendency to re- 
turn ; and, for at lead fome days after the 
firft attack, the irritability of the intef- 
tines, and their difpofition to fall into 
painful fpafmodic contractions, feem to 
continue. In this fituation, the repeti- 
tion of the opiates, for perhaps feveral 
days, may come to be neceffary ; and as 
the debility commonly induced by the 
difeafe favours the difpofition to fpaf- 
modic affections, it is often ufeful and 
neceffary, together with the opiates, to 
employ the tonic powers of the Peruvian 
bark *. 



* The bark in thefe cafes is often fuccefsfully given 
along with rhubarb, as in the following formula ; 



5 o PRACTICE 

R. Pulv. Cort. Peruv. l& 
Rad. Rhei, 3*- 
M. f. Pulv. in part, sequal. xii. dividend. 

One of thefe powders may be given thrice a-day 
with a glafs of port win*. 



CHAP, 



OF PHYSIC. 51 



CHAP. xr. 



OF 



B I A R R H <E A 



OR 



LOOSENESS. 



1465. HP HIS difeafe confifts in evacua- 
tions by ftool, more fre- 
quent and of more liquid matter than 
ufual. This leading and chara&eriftic 

+ iymptom 



5- 



PRACTICE 



fymptom is fo diverfified in its degree, 
in its caufes, and in the variety of matter 
evacuated, that it is almoft impoflible to 
give any general hiftory of the difeafe. 

1466. It is to be diftinguifhed from 
dyfentery, by not being contagious ; by 
being generally without fever ; and by 
being with the evacuation of the natural 
excrements, which are, at leaft for fome 
time, retained in dyfentery. The two 
difeafes have been commonly diftinguifh- 
ed by the gripings being more violent in 
the dyfentery ; and they are commonly 
lefs violent and lefs frequent in diar- 
rhoea: but as they frequently do occur 
in this alfo, and fomeftimes to a confidera- 
jble degree, fo they do not afford any pro- 
per diflinction *. 

1467. A" 

* Tenefmus is a diftinguifliing fymptom of dyfentery, ' 
but it is fometimes prefent in diarrhoea alfo ; efpecially 

thofe 



OF PHYSIC. 53 

1467. A diarrhoea is to be diftinguifh- 
cd from cholera chiefly by the difference - 
of their caufes ; which, in cholera, is of 
one peculiar kind; but in diarrhoea is 
prodigioufly diverfified, as we fhall fee 
prefently. It has been common to dif- 
tinguifh cholera by the evacuation down- 
wards being of bilious matter, and by 
this being always accompanied with a vo- 
miting of the fame kind ; but it does not 
univerfally apply, as a diarrhoea is fome- 
times attended with vomiting, and even 
of bilious matter. 

1468. The difeafe of diarrhoea, thus 

diftinguifhed, is very greatly diverfified; 

but in all cafes, the frequency of-ftools.^ 

I to be imputed to a preternatural increafe 

of the periftaltic motion in the whole, or 

at 

■ thofe diarrhoeas which proceed from acrid or putrid fub- 
flances in the interlines. 



j4 PRACTICE 

at leaft in a confiderable portion, of the 
inteftinal canal. This increafed action is 
in different degrees, is often convulfive 
and fpafmodic, and at any rate is a motus 
abnormis: for which reafon, in the metho- 
dical Nofology, I have referred it to the 
order of Spafmi, and accordingly treat of 
it in this place. 

1469. Upon the fame ground, as I con- 
fider the difeafe named Lientery to be an 
increafed periftaltic motion over the whole 
of the inteftinal canal, arifing from a pe- 
culiar irritability^ I have confidered it as 
merely a fpecies of diarrhoea. The idea 
of a laxity of the inteftinal canal being ' 
the caufe either of lientery, or other fpe- 
cies of diarrhoea, appears to me to be with- 
out foundation, except in the Angle cafe 
of frequent liquid ftools from a palfy 
of the jph'mffer am\ 

1470. The 



O F P H Y S I C. SS 

1470. The increafed action of the pe- 
riflaltic motion, I confider as always the 
chief part of the proximate caufe of diar- 
rhoea : but the difeafe is further, and in- 
deed chiefly, diverfified by the different 
caufes of this increafed action ; which we 
are now to enquire into. 

147 1. The feveral caufes of the increaf- 
ed action of the inteflines may be referred, 
I think, in the firft place, to two general 
heads. 

The jirjl is, of the difeafes of certain 
parts of the body which, either from a 
confent of the inteflines with thefe parts, 
or from the relation which the inteflines 
have^ to the whole fyftem, occafion an 
increafed action of the inteflines, with- 
out the transference of any flimulant mat- 
ter from the primary difeafed part to 
them. 

The 



J6 P R A t t I G ' £ 

The /?<:otf^ head of the caufes of the in- 
creafed action of the inteflines is of the 
flimuli of various kinds, which are ap- 
plied directly to the inteflines them- 4 

felveSi 

1472. That affections of other parts of 
the fyflem may affect the inteflines with- 
out transference or application of any fli- 
mulant matter, we learn from hence, that 
the paflions of the mind do jn fome per^ 
fons excite diarrhcea. , 

1473. That difeafes in other parts may 
in like manner affect the inteflines, ap- 
pears from the dentition of infants fre- 
quently exciting diarrhcea. I believe that 
the gout often affords another inflance of 
the fame kind ; and probably there are 
others alfo, though not well afcertain- 
ed. 

!* 2 1474, 'The 



OF PHYSIC. 57 

1474. The ftimuli (1471), tohich may 
be applied to the inteftines are of very va- 
rious kinds ; and are either* 

i. Matters introduced by the mouth; 

2. Matters poured into the inteftirie^ 
by the feveral exeretories opening into 
them. 

3. Matters poured from certain preter- 
natural openings made into theni in cer- 
tain difeafe's. 

1475. .Of thofe (1474. 1.) introduced 
by the mouth, the firft to be mentioned 
are the aliments commonly taken in. 
Too great a quantity of thefe taken in, 
often prevents their due digeftion in the 
ftomach ; and by being thus fent in; their 
crude, and probably acrid, ftate to the 

Vol. IV. E inteftines, 



5 8 PRACTICE 

inteftines, they frequently excite diar- 
rhoea. 

The fame aliments, though in proper 
quantity, yet hiving too great a propor- 
tion, as frequently happens, of faline or 
faccharine matter along with them, prove 
flimulant to the inteftines, and excite diar- 
rhoea. 

But our aliments prove efpecially the 
caufes of diarrhoea, according as they, 
from their own nature, or from the weak- 
nefs of the flomach, are difpofed to un- 
dergo an undue degree of fermentation 
there, and thereby become ftimulant to 
the inteftines. Thus acefcent aliments are 
ready to produce diarrhoea; but whether 
from their having any directly purgative 
quality, or only as mixed in an Over pro- 
portion with the bile, is not well determi- 
ned. 

1476. Not 



O F P H Y S I C. 59 

1476. Not only the acefcent, but alfo 
the putrefcent difpofition of the aliments^ 
feems to occafion a diarrhoea ; and it ap- 
pears that even the effluvia of putrid 
bodies, taken in any way in large quan- 
tity, have the, fame effect. 

Are oils or fats* taken in as part of our 
aliments, ever the caufe of diarrhoea ? 
and if fo, in what manner do they 
operate * ? 

1477. The other matters introduced by 
the mouth, which may be caufes of diar- 
rhoea, are thofe thrown in either as medi- 
cines, or poifons that have the faculty of 
flimulating the alimentary canal. Thus, 
in the lift of the Materia Medica, we have 
a long catalogue of thofe named pufga- 

E 2 tives j 

* Rancid oils and fats certainly irritate the interlines, 
and may therefore produce Diarrhoea. 



6o PRACTICE 

tives ; and in the lift of poifons, we harvr 
many poffeffed of the fame quality. The 
former given in a certain quantity, oc- 
casion a temporary diarrhoea; and given 
in very large dofes, may occafion it in, 
excefs, arid continue it longer than ufual, 
producing that fpecies of diarrhoea named 
a Hypercatharfis* 

1478. The matters (1474. 2.) poured 
into the cavity of the inteftines from the ' 
excretories opening into them, and which 
may occafion diarrhoea, are either thofe 
from the pancreatic or biliary duct, or 
thofe from the excretories in the coats 
of the inteftines themfelves. 

1479. What changes may happen in the 
pancreatic juice, I do not exactly know. 5. 
but I fuppofe that an acrid fluid may 
ilfue from the pancreas, even while ftill 
entire in its ftructure ; but more efpeci- 



OF P H Y S 1-C. 6s 

ally when it is in a fuppurated, fcirrhous, 
or cancerous ftate, that a very acrid matter 
may be poured out by the pancreatic du£t, 
and occalion diarrhoea. 

1480. We know well, that from the 
biliary duct the bile may be poured out 
in greater quantity than ufual ; and there 
is little doubt of its being alfo fometim.es 
poured out of a more than ordinary acrid 
quality. It is very probable, that in both 
ways the bile is frequently a caufe o£ 
diarrhoea. 

Though I have faid above that diar- 
rhoea may be commonly diftinguifhed 
from cholera, I muft admit here, that as 
the caufes producing that ftate of the bile 
which occafions cholera, may occur in 
all the different poflible degrees of force, 
fo as, on-one occafion, to produce the mod 
violent and diftinctly marked cholera; 
E 3 but, 



62 PRACTICE 

but, upon another, to produce only the 
gentleft diarrhoea ; which, however, will 
be the fame difeafe, only varying in de- 
gree. So I think it probable, that in 
warm climates, and in warm feafons, a 
diarrhoea biliofa of this kind may frequent- 
ly occur, not to be always certainly dif- 
tinguilhed from cholera. 

However this may be, it is fufficiently 
< probable, that, in fome cafes, the bile, 
without having been acred upon by the 
heat of the climate or feafon, may be re- 
dundant and acrid, and prove therefore 
a particular caufe of diarrhoea. 

148 1. Befide bile from thefeveral caufes 
and in the conditions mentioned the 
biliary duel may pour out pus, or other 
matter, from abfeeffes in the liver, which 
may be the Caufe of diarrhoea., 

Practical 



O F P H Y S I C. 63 

Practical writers take notice of a diar- 
rhoea wherein a thin and bloody liquid is 
difcharged, which they fuppofe to have 
proceeded from the liver, and have there- 
fore given the difeafe the name of Hepa- 
tirrhcea ; but we have not met with any 
inftance of this kind ; and therefore can- 
not properly fay any thing concerning 
it. 

* • 

1482. A fecond fet of excretories, from 
which matter is poured irito the cavity of 
the interlines, are thofe from the coats of 
the inteftines themfelves ; and are either 
the exhalants proceeding directly from the 
extremities of the arteries, or the excre- 
tories from the mucous follicles : and 
both thefe fources occur in prodigious 
number over the internal furface of the 
whole inteftinal canal. It is probable that 
it is chiefly the efFufion from thefe fources 
E 4 which 



64. PR A C T I C E 

which, in moft inflances, gives the mat* 
ter of the liquid ftools occurring in diar- 
rhoea, 

1483. The matter from both fourcesj 
may be poured out in larger quantity 
than ufual, merely by the increafed action, 
of the inteftines, whether that be excited 
by the paffions of the mind (1472), by 
difeafes in other parts of the fyftem, 
(147 1, 1.), or by the various ftimulants. 
mentioned ( r 475' and following) ; or the 
quantity of matter poured out may be in- 
creafed, not fo much by t;he increafed 
aclion of the inteflines, as by an increafed; 
afflux of fluids from_ other parts of thq 
fyftem. 

Thus, cold applied to the furface of the. 
^)ody, and fuppreiling perfpiration, may 

determine 



OF PHYSIC. 6$ 

determine a greater quantity of fluids to 
the inteftines. 



Thus, in the ifchuria renalis, the urins 
taken into the blood-vefTels is fometimes 
determined to pafs off again by the intef- 
tines, 

In like manner, pus or ferum may bet 
abforbed from the cavities in which they 
have been flagnant, and be again poured 
out into the inteftines, as frequently hap- 
pens, in particular with refpecl.to the wa» 
ter of dropfy. 

1484. It is to be obferved here, that a 
diarrhoea may be excited not only by a 
copious afflux of fluids from other parts of 
the fyftem, but likewife by the mere de- 
(f - termination of various acrid' matters from 
'i the mafs of blood into the cavity of the 
inteftines. Thus it is fuppofed that the 

morbific 



66 PRACTICE 

morbific matter of fevers is fometimes 
thrown out into the. cavity of the intef- 
tines, and gives a critical diarrhoea ; and 
whether I do or do not admit the doc- 
trine of critical evacuations, I think it is 
probable that the morbific matter of the 
exanthemata is frequently thrown upon 
the interlines, and occafions diarrhoea. 

1485. It is to" me further probable, that 
the putrefcent matter diffufed over the 
mafs of blood in putrid difeafes, is -fre- 
quently poured out by the exhalants into 
the inteftines, and proves there the caufe, 
at leaft in part, of the diarrhoea fo com- 
monly attending thefe difeafes. 

i486 1 . Upon this fubjecl: of the matters 
poured into the cavity of the inteftines, 
I have chiefly confidered them as poured 
out in unufual quantity: but it is proba- 
ble that, for the mod part, they are alfo 

changed' 



O F P H Y S I C. 6y 

changed in their quality, and become of 
a more acrid and ftimulant nature, upon 
which account efpecially it is that they 
excite, or at leaft increafe a diarrhcea. 

1487. How far, and in what manner, 
the exhalant fluid may be changed in its % 
nature and quality, we do not certainly 
know : but with refpect to the fluid from 
the mucous excretories, we know, that, 
when poured out in unufual quantity, 
it is commonly, at the fame time, in a 
more liquid and acrid form ; and may 
prove therefore, confiderably irritating. 

1488. Though the copious effufion of 
a more liquid and acrid matter from the 
mucous excretories, be pcobably owing to 
the matter being poured out immediately 
as it is fecreted from the blood into the 
mucous* follicles* without being allowed 
j.o ftagnate in the latter, fo as to acquire 
( that 



6S PRACTICE 

that milder quality and thicker confid- 
ence we commonly find in the mucus in 
its natural Hate ; and although we might 
fuppofe the excretions .of a -thin and acrid 
fluid fhould always be the efFect of every 
determination to the mucous follicles, 
and of every ftimulant applied to them.: 
yet it is certain, that the reverfe is fome- 
times the cafe ; and that, from the mu» 
cous follicles, there is frequently an in- 
creafed excretion of a mucus, which ap- 
pears in its proper form of a mild, vifcid., 
and thickifh matter. This commonly oc- 
curs in the cafe of dyfentery ; and it has 
been obferved to give a fpecies of diar- 
rhoea, which has been properly named the 
Diarrhea Mucofa, 

1489. A third fource of matter poured 
into the cavity of the inteftines, and occa- 
iioning diarrhoea (1474, 3.), is from thofe 
preternatural openings produced by dif- 

eafes 



OF PHYSIC. 6$ 

cafes in the inteftines or neighbouring 
parts. Thus the blood-veffels on the in- 
ternal furface of the inteftines may be o- 
pened by erofion, rupture, or anaftomo- 
fis, and pour into the cavity their blood, 
which, either by its quantity or by its a- 
<?rimony, whether inherent or acquired 
by ftagnation, may fometimes give a diar- 
rhoea evacuating bloody matter. This is 
what I think happens in that difeafe which 
has ,been called the MeUna or Morbus' 
Niger. 

1490. Another preternatural fource of 
matter poured into the cavity of the in- 
teftines, is the rupture of abfcefles feat- 
ed either in the coats of the inteftine* 
themfelves, or in any of the contiguous 
vifcera, which, during an inflamed ftate r 
had formed an adhefion with fome part of 
the inteftines. The matter thus poured 
into their cavity may be various j puru- 
*- lent. 



?o PRACTICE 

lent, or famous, or both together, mixed 
at the fame time with more or lefs of 
blood; and in each of thefe ftates may be 
a eaufe of diarrhoea. 

1 49 1. . Amongft the ftimuli that may- 
be directly applied to the inteftines, and 
which, by increafing their periitaltic mo- 
tion, may occafion diarrhcea, I muft not 
omit to mention worms, as having fre- 
quently that effect. 

1942. I mull alfo mention here a fiat© 
of the inteftines, wherein their periitaltic 
morion is preternatural] y increafed, and a 
diarrhcea produced ; and that is, when 
they are affected ' with an erythematic 
inflammation. With refpect to the ex- 
istence of fuch a itate, and its occafion- 
ing diarrhcea, fee what is faid above irt 
(398 and following). Whether it is to be 
confidered as a particular and diftinft cafe' 
3 of 



O F P H Y S I C. 71 

of diarrhoea, or is always the fame with 
fome of thofe produced by one or other 
of the caufes above mentioned, I have 
not been able to determine. 

1493. Laftly, by an accumulation of a- 
limentary or of other matter poured in- 
to the cavity of the inteftines from feveral 
of the fources above-mentioned, a diar- 
rhoea may be efpecially occafioned when 
the abforption of the lacteals, or of 
other abforbents, is prevented, either by 
an obftru&ion of their orifices, or by an 
obftrudlion of the mefenteric glands, 
through which alone the abforbed fluids 
can be tranfmitted. 

In one inftance of this kind, when the 
chyle prepared in the ftomach and duo- 
denum is not abforbed in the courfe of 
the inteftines, but pafTes off in confidera- 
ble quantity by the anus, the difeafe has * 

been- 



72 Practice 

been named Morbus C&liaeus, or firriply 
and more properly Cceliaca; which ac J 
cordingly I have considered as a fp^cies 
of diarrhoea; 

i 494. I have thus endeavoured to point 
out the various fpecies of difeafe that 
may come under the general appellation 
of Diarrhoea ; and from that emimera- 
tion it will appear, that many, and in- 
deed the greater part of the cafes of 
diarrhoea, are to be confidered as fympa^ 
thetic affections* and to be cured only b^ 
curing the primary difeafe upon which 
they depend ; of which, however, I can- 
hot properly treat here. From our enu- 
meration it will alfo appear^ that many of 
the cafes of diarrhoea which may be confi- 
dered as idiopathic, will not require my 
faying much of them here. In many in- 
ftances, the difeafe is afcertained, and alfo 
the caufe aiTigned, by the condition of 

. ' tbe 



O F P H Y S I C. 73 

the matter evacuated ; fo that what is ne- 
cefTary to correct or remove it will be fuffi- 
ciently obvious to practitioners of any 
knowledge. In fhort, I do not find that 
I can offer any general plan for the cure 
of diarrhoea ; and all that I can pretend 
to do on this fubject, is to give fome ge- 
neral remarks on the practice that has 
been commonly followed in the cure of 
this difeafe. 

1495. The practice in this difeafe has' 
chiefly proceeded upon the fuppofition of 
an acrimony in the fluids, or of a laxity 
in the fimple and moving fibres of the 
interlines ; and the remedies employed 
have accordingly been, Correctors of par- 
ticular acrimony, general demulcents, e- 
vacuants by vomiting or purging, aftrin- 
gents, or opiates. Upon each of thefe 
kinds of remedies I mall now offer fome 
remarks. 
Vol. IV. F 1496. An 



74 PRACTICE 

1496. An acrid acrimony is, upon fe- 
veral occafions, the caufe of diarrhoea, 
particularly in children ; and in fuch ca- 
fes the abforbent earths have been very 
properly employed. The common, how- 
ever, and promifcuous ufe of thefe have 
been very injudicious ; and where there 
is any putrefcency, they muft be hurt- 
ful. 

1497. The cafes in which there is a 
putrid or putrefcent acrimony prevailing, 
have been, I think, too feldom taken no- 
tice of; aod therefore, the ufe of acids 
too fcidom admitted. The acrimony to 
be fufpe&ed in bilious cafes, is probably 
of the putrefcent kind. 

1498. The general correctors of acri- 
mony are the mild diluents and demul- 
cents. The former have not been fo 
much employed in diarrhoea as they 

ought; 



O F P HY SIC. 7 s 

ought; for joined with demulcents, they 
very much increafe the effects of the lat- 
ter : and although the demulcents, both 
mucilaginous and oily, may by them- 
felvds be ufeful, yet without the aftiftance 
of diluents they can hardly be introduced 
in fuch quantity as to anfvver the pur- 
pofe *, 

F 2 M99* ^ 3 

* Lintfeed tea is both diluent and demulcent ; but 
as the patient fometimfis loaths it, we may in its place" 
ufe a deco&ion of marfh-mallow root, or of quince feed. 
Thefe infulions and deco£tions ought to be extremely- 
thin. An ounce of bruifed quince feed will make three. 
pints of water as thick and ropy as the white of an egg} 
hence a drachm is fufficient for a pint of the deco£Uon. , 

We have another inftance of a diluent and demulcent 
in the almond emulfion, which is an exceedingly elegant 
medicine. The formula in the London pharmacopoeia 
is not fo well adapted to cafes of diarrhoea, becaufe it 
contains fugar. That of the Edinburgh pharmacopoeia 



j6 PRACTICE 

1499. As indigeftion and crudities pre- 
fers in the ftomach are fo often the caufe 
of diarrhcea, vomiting imift therefore be 
frequently very ufeful in this difeafe. 

In like manner, when the difeafe pro- 
ceeds, as it often does, from obftructed per- 
fpiration, and increafed afflux of fluids ttr 
the inteftines, vomiting is perhaps the 
moft effectual means of reftoring the de- 
termination of the fluids to the furface of 
the body. 

It is poflible alfo, that vomiting may 
give fome inverfion of the periftaltic mo- 
tion which is determined too much down- 
wards in diarrhcea; fo that upon the 

whole 



is made with almond's and water alone, and is therefore 
preferable in thefe cafes. But the emulfio arabica of 
the Edinburgh pharmacopoeia is the beft diluent and cte- 
mulcent in cholera. 



O F P H Y S I C. 77 

whole it is a remedy which may be very 
generally ufeful in this difeafe *. 

1500. Purging has been fuppofed to be 
more univerfally neceflary, and has been 
more generally practifed. This, however, 
in my opinion, proceeds upon very mis- 
taken notions with refpec*l to the difeafe ; 
and fuch a practice {eems to me for the 
mall part fuperfluous, and in many cafes 
very hurtful. It goes upon the fuppofi-. 
tion of an acrimony prefent in the intef- 
tines, that ought to be carried ou? by 
purging: but if that acrimony has either 
been introduced by the mouth, or brought 
into the inteftines from other parts of the 
body, purging can neither be a means of 
F 3 correcting 

* The methods of giving the tartar emetic, for pro- 
ducing either vomiting or fweating, may be feen in the 
notes on article 185. 



78 PRACTICE 

correcting nor of exhaufting it ; and mud 
rather have the effect of increafing its 
afflux, and of aggravating its effects. 
From whatever fource the acrimony which 
can excite a diarrhoea proceeds, it may be 
fuppofed fufficient to evacuate itfelf, fo 
far as that can be done by purging ; and 
as in cholera, fo in the fame kind of diar- 
rhoea, it will be more proper to affift the 
evacuation by diluents and demulcents, 
than to increafe the irritation by purga, 
tives. 

1 50 1. If, then,, the ufe of purgatives in 
diarrhoea may be coniidered, even when 
an acrimony is prefent, as fuperfluous, 
there are many other cafes in which it 
may be extremely hurtful. If the irrita- 
bility of the interlines ihall, from affec 
tions in other parts of the fyftem, or other 
caufes, have been already very much in- 
creafed, purgatives mud neceffarily agr 

gravaje 



O F P H Y S I C. 79 

gravate the difeafe. In the cafe of lien- 
tery, nobody thinks of giving a purgative ; 
and in many cafes of diarrhoea approach- 
ing to that, they muft be equally impro- 
per. I have already obferved, that when 
diarrhoea proceeds from an afflux of fluids 
to the inteftines, whether in too great 
quantity, or of an acrid quality, purga- 
tives may be hurtful ; and whoever, there- 
fore confiders the numerous and various 
fources from which acrid matter may be 
poured into the cavity of the inteflines, 
will readily perceive, that, in many cafes 
of diarrhoea, purgatives may be extremely 
pernicious. 

There is one cafe in particular to be ta- 
ken notice of. When, from a general and 
acrid diflblution of the blood, the ferous 
fluids run off too copioufly in the cavity 
of the inteflines, and excite that diarrhoea 
which attends the advanced (late of hedlic 
F 4 fever, 



So PRACTICE 

fever, and is properly called a Colliqua- 
tive Diarrhoea j I have, in fuch cafes, often 
feen purgatives given with the mod bane- 
ful effects. 

There is ftill another cafe of diarrhoea 
in which purgatives are pernicious ; and 
that is, when the difeafe depends, as we 
have alleged it fometimes may, upon an 
crythematic inflammation of the intef» 
tineV. 

I need hardly add, that if there be a 
cafe of diarrhoea depending upon a laxity 
of the folids, purgatives cannot there be 
of any fervice, and may do much harm. 
Upon the whole, it will I think, appear, 
that the ufe of purgatives in diarrhoea is 
very much limited ; and that the promis- 
cuous ufe of them, which has been fo 
common, is injudicious, and often per- 
nicious. I believe the practice has been 
1 chiefly 



OF PHYSIC. 81 

chiefly owing to the ufe ofspurgatives in 
dyfenteric cafes, in which they are truly 
ufeful : becaufe, contrary to the cafe of 
diarrhoea, there is in dyfentery a confider- 
able conftriction of the inteftines *. 

1502. Another 

* Notwithstanding all the author advances concern- 
ing the danger qf purgatives in a diarrhoea, there are 
fome cafes in which they are of lingular utility. His 
•arguments in this article are doubtlefs juft ; and, in 
the fpecies of diarrhoea which he here enumerates, pur- 
gatives are certainly hurtful: but many inftances of 
diarrhoea occur, which proceed from an acrimony that 
is extremely tenacious, and that adheres clofely to the 
internal furface of the inteftines, or is retained in their 
folds. In fuch cafes purgatives are the only remedies 
for removing the difeafe, and ought therefore to be 
ufed. In all other cafes/ as the author juftly obferves; 
they are certainly pernicious. 

Having afcertained when purgatives are proper, the 
next consideration is, what purgatives ought to be ufed? 
The anfwer is obvious : — Neutral falts, particularly 
Soda Phofphorata, Rochel fait, Glauber's falts, and Ep- 

fom 



82 PRACTICE 

1502. Another fet of remedies employ- 
ed in diarrhoea are aftringents. There 
Jias been fome hefitation about the em- 
ployment of thefe in recent cafes, upon 
the fuppofition that they might occasion 
the retention of an acrid matter that 
mould be thrown out. I cannot, how- 
ever, well underftand or aflign the cafes 
in which fuch caution is neceflary ; and 
I think that the power of aftringents is 
feldom fo great as to render their ufe very 
dangerous. The only difficulty which 
has occurred to me, with refpecl to their 
ufe, has been to judge of the circumftan- 
ces to which they are efpecially adapted. 
It appears to me to be only in thofe where 

the 



Tom fait, which are enumerated in the order of their 
being agreeable, but in a contrary order to their degree 
of efficacy ; the Epfom fait being the leaft agreeable, 
but the moft efficacious. 



OF PHYSIC. 83 

the irritability of the inteftines depends 
upon a lofs of tone ; and this, I think, may 
occur either from the debility of the whole 
fyftem, or from caufes acting on the intef- 
tines alone. All violent *>t long continued 
fpafmodic and convulfive affections of the 
inteftinal canal neceflarily induce a de- 
bility there: and fuch caufes often take 
place, from violent irritation, in colic, dy- 
fentery, cholera, and diarrhoea *. 

1503. The 

' * The aftringents to be ufed, when they are proper, 
are various : as Alum,. Logwood, Catechu, Rhubarb, 
&.c. The author juftly remarks, that aftringents are 
only ufeful in cafes of debility, and therefore the tonic 
aftringents are undoubtedly preferable to any other. 
Rhubarb and Peruvian bark, each pofleffing both thefe 
qualities, may therefore be advantageoufly ufed con- 
jointly, as in the following formula. 

R. Pulv. Cort. Peruv. fi. 
Rad. Rhei, 3 fl. 
.M.f. Pulv. 

The 



S 4 PRACTICE 

1503. The laft of the remedies of diar- 
rhoea that remain to be mentioned are 
opiates. The fame objections have been 
made to* the ufe of thefe, in recent cafes 
of diarrhoea, as to that of aftringents ; but 



on 



The dofe of this powder may be varied according to 
circumftances, from a fcruple to a drachm, twice a-day, 
with a glafs of port wine after it. 

It may not be improper to obferve, that in diarrhoeas) 
in general, peculiar attention mull be paid to diet. The 
oleraceous and acefcent vegetables muft be carefully a- 
voided ; as muft alfo all fermented liquors except port 
wine. Of the farinaceous vegetables, rice is the beft ; 
and rice-water, with a little cinnamon and port wine, is 
the moil proper drink for patients in thefe cafes. Roaft- 
ed meats are preferable to boiled ; and veal, lamb, or 
chickens, preferable to beef or mutton. Pork is very 
improper ; as are alfo all kinds of fifh. Puddings of all 
Jdnds without fruit are very proper food for fuch pa- 
tients, efpecially rice-puddings made without eggs, but 
with milk and cinnamon ; and alfo rice-milk, fago 
with port wine, blanc mange, &c. 



OF PHYSIC' 85 

011 no good grounds : for the effect of opi- 
ates, as aftringent, is never very perma- 
nent ; and an evacuation depending upon 
irritation, though it may be for fome time 
fufpended by opiates, yet always returns 
very foon. It is only by taking off irri- 
tability that opiates are ufeful in diar- 
rhoea ; and therefore, when the difeafe 
depends upon an increafe of irritability 
alone, or when, though proceeding from 
irritation, that irritation is corrected or 
exhaufted, opiates are the mofl ufeful and 
certain remedy. And though opiates 
are not fuited to correct or remove an ir- 
ritation applied, they are often of great 
benefit in fufpending the effects of thafc 
irritation whenever thefe are violent : 
and, upon the whole, it will appear, that 
opiates may be very frequently, and with 
great propriety, employed in the cure of 
-diarrhoea. 

/ CHAR 



86 PRACTICE 



CHAP. XII. 



OF THE 



DIABETES. 



1504. HP HIS difeafe connfts in the 
•*■ voiding of an unufually 
large quantity of urine. 



As hardly any fecretion can be increas- 
ed without an increafed action of the vef- 

fela 



OF PHYSIC. 87 

fcls concerned in it, and as fome inftances 
of this difeafe are attended with affections 
manifestly fpafmodic, I have had no doubt 
of arranging the diabetes under the order 
of Spafmi. 

1505. This difeafe is always accompa- 
nied with a great degree of thirft, and 
therefore with the taking in of a great 
quantity of drink. This in fome mea- 
fure accounts for the Very extraordinary 
quantities of urine voided : but ftill, inde- 
pendent of this, a peculiar difeafe certain- 
ly takes place; as the quantity of urine 
voided does almoft always exceed the 
whole of the liquids, and fometimes the 
whole of both folids and liquids, taken 
in. 

1506. The urine voided in this difeafe 
is always very clear, and at firft fight 
appears entirely without any colour; 

but, 



88 PRACTICE 

but, viewed in a certain light, it gene- 
rally appears to be flightly tinged with 
a yellowifh green, and in this refpec"l 
has been very properly compared to a 
folution of honey in a large proportion 
of water. , 

Examined by the tafte, it is very gene- 
rally found to be more or lefs fweet ; and 
many experiments that have now been 
made in different inftances of the difeafe 
fhow clearly that fuch Urine contains, in 
confiderable quantity, a faccharine matter 
which appears to be very exactly of the 
nature of common fugar. 

1507. Doctor Willis feems to me to 
have been the firft who took notice of the 
fweetnefs of the urine in diabetes, and 
almoll every phyfician of England has 
fince taken notice of the fame. It is to be 
doubted, indeed, if there is any cafe of 

idiopathic 



OF PHYSIC. 89 

idiopathic diabetes in which the urine is 
of a different kind. Though neither the 
ancients, nor, in the other countries of 
Europe, the moderns, till the latter were 
directed to it by the Englifh, have taken 
notice of the fweetnefs of the urine, it does 
not perfuade me, that either in ancient 
or in modern times the urine in diabetes 
was of another kind. I myfelf, indeed, 
think I have met with one inftance of dia- 
betes in which the urine was perfectly 
infipid ; and it would feem that a like ob- 
fervation had occurred to Dr Martin Lif- 
ter. I am perfuaded, however, that fuch 
inftances are very rare ; and that the other 
is by much the more common, and per- 
haps the almoft univerfal occurence. I 
judge, therefore, that the prefence of fuch 
a faccharine matter may be confidered as 
the principal circumftance in idiopathic 
diabetes ; and it gives at lead the only 
cafe jof that difeafe that I can properly 
Vol. IV. G ; treat 



9 o PRACTICE 

treat of here, for I am only certain that 
what I am further to mention relates to 
fuch a cafe.. 

1508. The antecedents of this difeafe,. 
and confequently the remote caufes of it, 
have not been well afcertained. It may 
be true that it frequently happens to men - 
who, for a long time before, had been in- 
temperate in drinking ; that it happens to 
perfons of a broken conftitution, or who, 
as we often exprefs it, are in a cachectic 
flate ; that it fometimes follows intermit- 
tent fevers ; and that it has often occur- 
red from excefs in drinking of mineral 
waters. Eut none of thefe caufes apply 
very generally to> the cafes' that occur : 
fuch cafes are not always, nor even fre- 
quently, followed by a diabetes ; and 
there are many inftances of diabetes which 
could not be referred to any of them. 
In molt of the cafes of this difeafe which 

I 



O F P H Y S I C. 91 

I have met with, I could not refer it to 
any particular caufe. 

1509. This difeafe commonly comes oil 
flowly, and almoft imperceptibly,, with* 
out any previous diforder. It often arifes 
to a confiderable degree, and fubfifts long 
without being accompanied with evident 
diforder in any r particular part of the fyf- 
tern. The great third which always, 
and the voracious appetite which frequent- 
ly, occur in it, are often the only remark- 
able fymptoms. Under the continuance 
of the difeafe, the body is often greatly 
emaciated ; and a great weaknefs alfo pre- 
vails. The pulfe is commonly frequent ; 
and an obfcure fever is for the moil part 
prefent. When the difeafe proves fatal, 
it generally ends with a fever, in many 
circumflances, particularly thofe of ema- 
ciation and debility, fimilar to and refem- 
bling a hectic* 

G 2 15 10. The 



9 2 PRACTICE 

1 510. The proximate caufe of this dif- 
eafe is not certainly or clearly known. It 
feems to have been fometimes connected 
with calculous affections of the kidneys ; 
and it, is poflible, that an irritation appli- 
ed there may increafe the fecretion of u- 
rine. It perhaps often does fo ; but how 
it mould produce the fingular change that 
takes place in the ftate of the urine, is not 
to be eafily explained. It certainly often 
happens, that calculous matters are long 
prefent in the urinary paffages, without 
having any fuch effect as that of produ- 
cing diabetes in any fhape. 

Some have fuppofed that the difeafe 
occurs from a relaxed ftate of the fecreto- 
ry veffels of the kidneys j and indeed the 
directions of perfons who had died of this 
difeafe have fhown the kidneys in a very 
flaccid ftate. This, however, is probably 



OF PHYSIC. 93 

to be confidered as rather the effect than 
the caufe of the difeafe. 

That no topical affection of the kid- 
neys has a fhare in producing this dif- 
eafe, and that a fault in the aflimilation 
of the fluids is rather to be blamed, I 
conclude from hence, that even the fblid 
food taken in, increafes the quantity of 
the urine voided, at the fame time with 
an increafe of the faccharine matter above 
mentioned. 

151 1. The diabetes has been fuppofed. 
to be owing to a certain ftate of the bile ; 
and it is true, that this difeafe has fome- 
times ' occurred in perfons who were at 
the fame time affected with difeafes of the 
liver : but this occurrence does nor. ofcen 
take place ; and the diabetes frequently 
occurs feparately from any affection of 
the liver. In twenty inftances of diabetes 
G 3 which 



94 PRACTICE 

which I have feen, there was not in any 
one of them any evident affection of the 
liver. 

The explanation that has been offered 
of the nature and operation of the bile, in 
producing diabetes, is very hypothetical, 
and nowife fatisfying, 

15 1 2. As I have already faid, I think 
it probable, that in mod cafes the proxi- 
mate caufe of this difeafe is fome fault 
in the affimilatory powers, or in thofe 
employed in converting alimentary mat- 
ters into the proper animal fluids. This 
I formerly hinted to Dr Dobfon, and 
it has been profecuted and publifhed 
by him ; but I mud own that it is a 
theory embarraffed with fome difficulties 
which I cannot at prefent very well re- 
move, 

15 13. The 



O F P H Y S I C. 95 

15 1 3. The proximate caufe of diabetes 
being fo little known or afcertained, I 
cannot propofe any rational method of 
cure in the difeafe *. From the tefti- 
mony of feveral authors, I believe that 
the difeafe has been cured : but I believe 
G 4 alfo, 

* The difeafe is happily not very common : but, 
when a phyfician is called, he is under the neceffity of 
doing fomething, and not remaining inactive. Some 
general di/rections may therefore be acceptable to the 
young practitioner. 

The cure will principally confift in avoiding whatever 
may relax the renal veffels, efpecially by avoiding ftrong 
drink. As the quantity of urine is always lefs in pro- 
portion as the perfpiration is increafed, it feems advife- 
able to keep the furface of the fkin lax and perfpirable ; 
and, if the patient's ftrength allows him, he ought fre- 
quently to ufe bodily exercife to promote fweat. For 
a fimilar reafon, external cold mull be avoided, becaufe 
by diminifliing perfpiration, a larger quantity of fluids ' 
is derived to the kidneys. 

In 



96 PRACTICE 

alfo, that this has feldom happened j and 
when the difeafe has been cured, I doubt 
much if it was effected by the feveral re- 
medies to which thefe cures have been 
afcribed. In all the inftances of this dif- 
eafe which I myfelf have feen, and in fe- 
veral others of which I have been inform- 
ed, no cure of it has ever been made in 
Scotland, though may inftances of it have 
occurred, and in moft of them the reme- 
dies recommended by authors have been 
diligently employed. I cannot, therefore, 
with any advantage, enter into a detail of 
thefe remedies ; and as the difeafe, toge- 
ther with its feveral circumftances, when 
they fhall hereafter occur, is likely to be- 
come the fubjecl of diligent invefligation, 
I avoid going farther . at prcfent, and 

judge 

In feme cafes the difeafe may be probably owing to 
a lax or weak flate of the kidneys : hence the indication 
of tonics, as Peruvian bark, and other tonic bitters. 



OF PHYSIG 97 

judge it prudent to fufpend my opinion 
till I fhall have more obfervations and ex- 
periments upon which I can form it more 
clearly. 



CHAP. 



q3 PRACTICE 



CHAP. XIII. 



OF THE 



HYSTERIA, 



OR THS 



H Y S T ER I C DISEASE. 



I 5 I 4« HTHE many and various fymp- 

toms which have been fup- 

pofed to belong to a difeafe under this 

appellation, 



O F P H Y S I C. 99 , 

appellation, render it extremely difficult 
to give a general character or definition 
of it. It is, however, proper in all cafes 
to attempt fome general idea ; and there- 
fore, by taking the moft common form, 
and that concurrence of fymptoms by 
which it is principally diftinguifhed, I 
have formed a character in my fyftem of 
Methodical Nofdlogy, and fhall here en- 
deavour to illuftrate it by giving a more 
full hiflory of the phenomena. 

, 15 1 5. The difeafe attacks in paroxyfms 
or fits. They commonly begin by fome 
pain and fulnefs felt in the left fide of 
the belly. From this a ball * feems to 
move with a grumbling noife into the 
other parts of the belly ; and, making 
as it were various convolutions there, 

feems 

* Commonly called Globus hyjlericus by authors. 



ioo PRACTICE 

feems to move into the ftomach ; and 
more di^inctly (till rifes up to the top 
of the gullet, where it remains for fome 
time, and by its preffure upon the la- 
rynx gives a fenfe of rufljbcation. By ithe 
time that the difeafe has proceeded thus 
far, the patient is affedled with a flupor 
a«d infenfibility, while at the fame time, 
the body is agitated with various convul- 
lions. The trunk of the body is wreathed 
to and fro, and the limbs are varioufly a- 
gitated ; commonly the convulfive mo- 
tion of one arm and hand, is that of 
beating with the clofed fill upon the 
bread very violently and repeatedly. This 
ftate continues for fome time, and has 
during that time fome remiffions and- 
renewals, of the convulfive motions \ but 
they at length ceafe, leaving the patient 
in a ftupid and feemingly fleeping ftate. 
More or lefs fuddenly, and frequently 
with repeated fighing and fobbing, toge- 
ther 



,,0F PHYSIC. 101 

ther with a murmuring noife in the bel- 
ly, the patient returns to the exercife of 
fenfe and motion, but generally without 
any recollection of the feveral circum- 
ftances that had taken place during the 
fit. 

15 1 6. This is the form of what is call- 
ed an hyjieric paroxyjtn, and is the mod 
common form ; but its paroxyfms are 
confi^lerably varied in different perfons, 
and even in the fame perfon at dif- 
ferent times. It differs, by having more 
or fewer of the circumftances above- 
mentioned j by thefe circumftances being 
more or lefs violent ; and by the different 
duration of the whole fit. , 

Before tjie fit, there is fometimes a fud- 
den and unufually large flow of limpid 
urine. At the coming on of the fit the 

ftomach 



102 PRACTICE 

llomach is fometimes affected with vomit- 
ing, the lungs with confiderable difficulty 
of breathing, and the heart with palpita- 
tions. During the fit, the whole of the 
belly, and particularly the navel, is drawn 
ftrongly inwards ; the fphincter ani is 
fometimes fo firmly conflicted as not to 
admit a fmall glyfter pipe, and there is 
at the fame time an entire fuppreffion of 
urine. Such fits are, from time to time, 
ready to recur ; and during the intervals 
the patients are liable to involuntary mo- 
tions, to fits of laughing and crying, with 
fudden tranfitiqn from the one to the 
other ; while fometimes falfe imagina- 
tions, and fome degree of delirium alfo 
occur. 

1 51 7. Thefe affections have been fup* 
pofed peculiar to the female fex : and in- 
deed they moil commonly appear in fe- 
males : but they fometimes, though rarely, 

attack 



O F P H Y S I C. 103 

attack alfo the male fex ; never, however, 
that I have obferved in the fame exquifite 
degree. 

In the female fex, the difeafe occurs 
efpecially from the age of puberty to that 
of thirty-five years ; and though it does 
fometimes, yet it very feldom appears be- 
fore the former or after the latter of thefe 
periods. 

At all ages, the time at which it mod 
readily occurs is that of the menjftrual 
period. 

The difeafe more efpecially affects the 
females of the moft exquifitely fanguine 
and, plethoric habits; and frequently af- 
fects thofe of the moft robufl and maf- 
culine conftitution. 

It affects the barren more than the 

breeding 



104 PRACTICE 

breeding women, and therefore frequent- 
ly young widows. 

It occurs efpecially in thofe females 
who are liable to the Nymphomania ; and 
the Nofologifls have properly enougji 
marked one of the varieties of this difeafe 
by the title of Hyjleria Libidinofa. 

In the perfons liable to the fits of this 
difeafe, it is readily excited by the paf- 
lions of the mind, and by every confider- 
able emotion, efpecially thofe brought on 
by furprife. 

The perfons liable to this difeafe ac- 
quire often fuch a degree of fenfibility, 
as to be ftrongly affected by every impref- 
fion that comes upon them by furprife. 

15 1 8. In this hiftory, there appears to 
be a concurrence of fymptoms and cir- 

cumftances 



O F P H Y S I C. 105 

ciimftances properly marking a very par- 
ticular difeafe, which I think may be dif- 
tinguifhed from all others. It feems to 
me to have been improperly confidered 
by phyficians, as the fame with fome o- 
ther difeafes, and particularly with hy- 
pochondriafis. The two difeafes may 
have fome fymptoms in common, but for 
the moft part are confiderably different. 

Spafmodic affections occur in both dif- 
eafes ; but neither fo frequently nor to 
fo great a degree, in hypochondriafis as 

in hyfteria. 
« 

Perfons liable to hyfteria are fometimes 
affected at the fame time with dyfpepfia. 
They are often, however, entirely free 
from it ; but I believe this never happens 
to perfons affected with hypochondria- 
fis. 

Vol. IV. H Thefe 



io6 PRACTICE 

Thefe different circumftances mark 
fome difference in the two difeafes ; but 
they are ftill more certainly diftinguifhed 
by the temperament * they attack, and 
by the time j* of life at which they ap- 
pear to be mod exquifitely formed. 

It has been generally fuppofed, that the 
two difeafes differ only in refpect of 
their appearing in different fexes. But 
this is not well founded : for although 
the hyfteria appears moft commonly in 
females, the male fex is not abfolutely 
free from it, as I have obferved above ; 
and although the hypochohdriafis may 

be 

* Hyfteria attacks the fanguine and plethoric, but 
Hypochondriafis the melancholic. 

f Hypochondriafis fcarcely ever appears early 
in life, nor Hyfteria late : and Hypochondriafis 
becomes aggravated, but Hyfteria relieved by advanc- 
ing age. 



O F P H Y S I C. 107 

be moft frequent in men, the inflances 
of it in the female fex are very com- 
mon*. 

15 19. From all thefe confederations, it 
muft, I think, appear, that the hyfteria 
may be very well, and properly, diftin- 
guiflied from hypochondnafis. 

Further, it feems to me to have been 
■with great impropriety, that almoft eve- 
ry degree of the irregular motions of the 
nervous fyftem has been referred to the 
one or other of thefe two difeafes. Both 
are marked by a peculiarity of tempera- 
ment, as well as by certain fymptoms 
commonly accompanying that ; but fome 
of thefe, and many others ufually mark- 
ed by the name of nervous fymptoms, 
H 2 may, 

The Hypochondriafis in women has been frequent- 
ly rniftaken for Hyfteria. 



Io8 PRACTICE 

may* from various caufes, arife in tem- 
peraments different from that which is pe- 
culiar to either hyfteria or hypochondria- 
sis, and without " being joined with the 
peculiar fymptoms of either the one or 
the other difeafe : fo that the appellations 
of Hyfteric and Hypochondriac are very 
inaccurately applied to them. Under 
what view thefe fymptoms are otherwife 
to be confideredi I am not ready to deter- 
mine : but mud remark, that the appel- 
lation of Nervous Difeafes is too vague 
and undefined to be of any ufeful appli- 
cation. 

1520. Having thus endeavoured to 
diftinguifh hyfteria from every other 
difeafe, I fhall now attempt its peculiar 
pathology. With refpect to this, I think 
it will, in the firft place, be obvious that 
its paroxyfms begin by a convulfive and 
fpafmodic affection of the alimentary 

canal, 



O F P H Y S I C. 109 

canal, which is afterwards commu- 
nicated to the brain, and to a great 
part of the nervous fyftem. Although 
the difeafe appears to begin in the ali- 
mentary canal, yet the connection which 
the paroxyfms fo often have with the 
menftrual flux, and with the difeafes 
that depend on the flate of the genitals, 
fhows, that the phyficians have at all 
times judged rightly in confidering this 
difeafe as an affection of the uterus and 
other parts of the genital fyftem. 

152 1. With regard to this, however, 
I can go no farther. In what manner the 
uterus, and in particular the ovaria, are 
affected in this difeafe ; how the affection 
of thefe is communicated, with particu- 
lar circumftances, to the alimentary ca-f 
nal ; or how the affection of this, riling 
upwards, affects the brain, fo as to occa- 
fion the particular convulfions which oc- 
H 3 cur 



no PRACTICE 

cur in this difeafe, I cannot pretend to 
explain. 

i 
But although I cannot trace this difeafe 
to its firft caufes, or explain the whole of 
the phenomena, I hope, that with refpect 
to the general nature of the difeafe, I 
may form fome general conclufions, which 
may ferve to direct our conduct in the 
cure of it. 

1522. Thus, from a confideration of 
the predifponent and occafional caufes, it 
will, I think, appear, that the chief part 
of the proximate caufe is a mobility of 
the fyftem, depending generally upon its 
plethoric ftate. 

1523. Whether this difeafe ever arifes 
from a mobility of the fyftem, inde- 
pendent of any plethoric ftate of it, I can- 
not pofitively determine j but in many 

cafei 



OF PHYSIC. in 

cafes that have fubfifted for fpme time, 
it is evident that a fenfibility, and con- 
fequently a mobility, are acquired, which 
often appear when neither a general ple- 
thora can be fuppofed to fubfift, nor an 
occafional turgefcence to have happened. 
However, as we have fhown above, that 
a diftention of the vefTels of the brain 
feems to occafion epilepfy, and that a tur- 
gefcence of the blood in the vefTels of the 
lungs feems to produce afthma ; fo ana- 
logy leads me to fuppofe, that a turgef- 
cence of blood in the uterus, or in other 
parts of the genital fyftem, may occafion 
the fpafmodic and convulfive motions 
which appear in hyfteria. It will, at the 
fame time, be evident, that this afFeclion 
of the genitals mud efpecially occur in 
plethoric habits ; and every circumftance 
mentioned in the hiflory of the difeafe 
ferves to confirm this opinion with ■ re- 
fpect to its proximate caufe. 

H 4 J 5 2 4 From 



ii2 PRACTICE 

1524. From this view of the fubjeclj 
the analogy of hyfteria and epilepfy will 
readily appear; and why, therefore, I am 
to fay that the indications of cure are the 

fame in both *. 

As 

* Although the indications of cure may be the fame 
in both difeafes, yet in hyfteria we are more frequent- 
ly under the neceffity of relieving the violence of the 
fymptoms than in epilepfy ; and for this purpofe we 
muft have recourfe to a variety of antifpafmodics. 

Afafcetida, in various forms, is ufually employed; 
as are alfo volatile fpirits ; but both thefe joined prove 
more efficacious than either of them fingly. There are 
excellent formulae of this kind in the London and E- 
dinburgh pharmacopoeias, under the title of Spiritus 
Ammoniae'fcetidus. Its dofe is twenty or thirty drops, 
repeated according to the urgency of the cafe, feveral 
times a-day. 

The Tjn&ura Caftora compofita of the Edinburgh 
pharmacopoeia is another excellent formula of the fame 

kind : 



O F P H Y S I G 113 

As the indications, fo the feveral means 
pf anfwering them are fo much the fame 



in 



kind : it is a remedy of real efficacy. The dofe of it is 
thirty or forty drops repeated occafiorially. 

The Tin&ura Valerianae ammoniata of both the 
pharmacopoeias is alfo frequently ufed. Its dofe is a, 
tea-fpoonful or two. 

Few of the compofitions of the fhops are found to be 
more efficacious antifpafmodics than the Spiritus JEthe- 
ris Vitriolicus compofitus of the London Pharmaco- 
poeia. Its dofe is from thirty to fifty drops in two or 
three fpoonfuls of cold water ; and it muft be fwallow- 
ed immediately on pouring it out of the vial. 

Thefe and other antifpafmodics may be ufed promif- 
cuoufly ; for, in different cafes and conftitutions, they 
prove differently efficacious. Sometimes they may be 
varioufly combined with one another, and with opium. 
Opium, however, ought not to be ufed, except where 
other antifpafmodics fail, as it always leaves the patient 

remarkably 



ii4 PRACTICE 

in both difeafes, that the fame obferva- 
tions and directions, with regard to the 

choice 

yemarkably low, and liable to the return of the pa- 
roxyfms. 

Befides the ufe of thefe remedies internally, fome of 
them may be ufefully employed externally; as ftrong 
volatile fpirits to the nofe, the vitriolic ether to the 
temples, &c. 

Thefe remedies are chiefly defigned for occasionally 
removing the violence of fymptoms ; • but the fetid 
gums,, in fubftance, muft be ufed, when we wifh to 
produce permanent effects. The formulae of them are 
in both our pharmacopoeias, under the title of Pilulas 
Galbani compoiitae in the London, and Pilulae Afafoe- 
tidae compofitae in the Edinburgh . Pharmacopoeia ; but 
they will be found much more efficacious by adding 
to them a little caftor, as in the following formula : 

R. Pilul. Galban. comp. i& 
Caftor. Ruflic, 3i. 

Syr. 



O F P H Y S I C. 115 

choice and employment of tbefe reme- 
dies, that have been delivered above on 
the fubjecl: of epilepfy, will apply pretty 
exactly to hyfteria; and therefore need 
not be repeated here. ( 

CHAP. 

Syr. fimpl. q. s. 

M. f. maff. in pilulas lxxv. equales dividend. 

Five of thefe pills many be taken twice-ra day, walk- 
ing them down with a tea-cupful of cold water, with a 
tea-fpoonful of volatile tinfture of valerian in it. 

The Pilulae fcetidae of the Swediih Pharmacopoeia, in 
which caflor is one of the ingredients, is preferable to 
any of our fetid gum pills. 



ii6, PRACTICE 



CHAP. IX. 



®F 



CANINE MADNES 



AND 



HYDROPHOBIA. 



1 S 2 5' HT^HIS difeafe has i been Co exad- 

-*- ly and fully defcribed in 

books that are in every body's hands, that 

it is on no account neceflary for me to 

give 



O F P H Y S I C. 117 

give any hiftory of it here ; and with 
refpect to the pathology of it, I find that 
I can fay nothing fatisfying to myfelf, or 
that I can expect to prove fo to others. 
I find alfo, with refpect to the cure of this 
difeafe, that there is no fubject in which 
the fallacy of experience appears more 
ftrongly than in this. From the moft an- 
cient to the prefent times, many remedies 
for preventing and curing, this difeafe 
have been recommended under the fanc- 
tion of pretended experience, and have 
perhaps alfo I?:ept their credit for fome 
time : but fucceeding times have general- 
ly, upon the fame ground of experience, 
deftroyed that credit entirely; and moft 
of the remedies formerly employed are 
now fallen into abfolute neglect. In the 
prefent age, fome new remedies have been 
propofed, and have experience alleged to 
vouch for their efficacy ; but many doubts 
ftill remain with refpect to this : and 

though 



ii8 PRACTICE 

though I cannot determine in this matter 
from my own experience, I think it in- 
cumbent on me to give the beft judge- 
ment I can form with refpe£t to the 
choice of the remedies at prefent recom- 
mended* v 

1526. I am, in the firft place, firmly 
perfuaded, that the mod certain means' of 
preventing the confequences of the bite, 
is to cut out, or otherwife deftroy, the part 
in which the bite has been made. In this 
every body agrees ; but with this differ- 
ence, that fome are of opinion that it can 
only be effectual when it is done very 
foon after the wound has been made, 
find they therefore negledl it when this 
opportunity is miffed. There have been, 
however, no experiments made proper to 
determine this matter: and there are ma- 
ny confiderations which lead me to think, 
that the poifon is not immediately com- 
municated 



OF PHYSIC. 119 

municated to the fyftem ; and therefore, 
that this meafure of deftroying the pare 
may be pradtifed with advantage, even 
many days after the bite has been given. 

1527. Whilft the ftate of our .experi- 
ence with refpeel to feveral remedies now 
in ufe, is uncertain, I cannot venture to 
afTert that any of thefe is abfolutely inef- 
fectual ; but 1 can give it as my opinion, 
that the efficacy of mercury, given very 
largely, and perfifted in for a long time, 
both 'as a means of preventing the difeafe, 
and of curing it when it has actually 
come on, is better fupported by experience 
than that of any other remedy now pro- 
pofed or commonly employed. 



BOOK. 



BOOK IV, 



OF 



V E S A N I M, 



OR, OF THE 

DISORDERS of the INTELLECTUAL 
FUNCTIONS. 



CHAP. I. 

Of Vesani^e in General. 

1528. "T^HE Nofologifts, Sauvages and 

"* Sagar, in a clafs of difeafes 

under the title of VesanI^e, have com- 

Vol. IV. I prehended 



142 PRACTICE 

prehended the two orders, of Hallueina- 
tiones or Falfe Perceptions, and of. Moroji? 
tates K or Erroneous Appetites and Paflions; 
and, in like' manner, Linnaeus in his clafs 
of Men tales, correfponding to the-Ve* 
faniae of Sauvages, has comprehended the 
two orders of Imaginarii and G B athetici,, 
nearly the fame with the Hallueinationes 
and Morofitates of that author. This, 
however, from.feveral confiderations, ap- 
pears to me improper; and 1 have there- 
fore formed a clafs of Vefaniae nearly the, 
fame with the Paranoiae: of Voggl, ex? 
eluding from it the Hallueinationes and 
Morofitates, which I have referred to the 
Morbi Locales. Mr Vogel has done the 
like, in feparating from the Paranoias the 
falfe perceptions and erroneous appetites ; 
and has thrown thefe into another clafs, 
to which he has giveii the title of Hype- 
rsefthefes. - 

j 52.9. It 



O F P tt Y S I C. 123 

1^29. It is indeed true, that certain 
hallucinationes and morofitates are fre- 
quently combined with what I propofe 
to confider as ftrictly a vefania or an er- 
roneous judgement ; and fometimes the 
hallucinationes ieem to lay the founda- 
tion of, and to form almoft entirely* the 
vefania. But as mod part of the halluci- 
nationes enumerated by the Nofologifts 
are affections purely topical, and induce 
no other error of judgement befide that 
which relates to the fingle object of the 
fenfe or particular organ affected; fo thefe 
are certainly to be feparated from the 
difeafes which confift in a more general 
affection of the judgement. Even when 
the hallucinationes constantly accompa- 
ny or feem to induce the vefania, yet be- 
ing fuch as arife from internal caufes, 
and mdy be prefumed to arife from 
the fame caufe as the more general af- 
fection of the judgement, they are there - 
I 2 fore 



1^4 PRACTICE 

fore to be confidered as fymptoms of 
this only. 

In like manner I judge with refpeel to 
the morofitateSj or erroneous paffions, 
that accompany vefania ; which, as con- 
fequences of a falfe judgement, muft be 
confidered as arifing from, the fame caufes, 
and as fymptoms only, of the more gene- 
ral affection. 

There is,, indeed^ one cafe of a morofitas 
which, feems to induce a vefania, or more 
general affection of the judgement ; and 
this may lead us to confider the vefania, 
in this cafe, as a fymptom of an erroneous 
appetite, but will not afford any good 
reafon for comprehending the morofita- 
tes in general under the vefanias, confide- 
red as primary difeafes. 

The 



OF PHYSIO, 125 

The limitation, therefore, of the clafs of 
Vefanioe to the lefions of our judging fa- 
culty, feems from every confideration to 
t>e proper. 

The particular difeafes to be compre- 
hended under this clafs, may be diftin- 
guifhed according as they affect perfons 
in the -time, of waking or fleeping. Thofe 
which affect men awake, may again be 
confidered, as they confift in an erroneous 
judgement, to which I fhall give the ap- 
pellation of Delirium; or as they confift 
in a weaknefs or imperfection of judge- 
ment, which I fhall name Fatuity. I 
begin with the confideration of Deliri- 
um. 

1530. As men differ greatly in the 

foundnefs and force of their judgement, 

fo it may be proper here to afcertain 

more precifely what error or imperfection 

I 3 of 



126 P R A C TICE 

of our judging faculty is to be confidered 
as morbid and to admit of the appella- 
tions of /Delirium and Fatuity. In doing 
this, I mall firft confider the morbid er- 
rors of judgement under the general ap- 
pellation of Delirium, which has been 
commonly employed to denote every 
mode of fuch error. 

153 1. As our judgement is chiefly ex- 
ercifed in difcerning'and judging of the 
feveral relations of things, I apprehend 
that delirium may be defined to be,-^ 
In a perfon awake, a falfe or miftaken 
judgement of thofe relations of things, 
which as occurring rnoft frequently in 
life, are thofe about which the genera-* 
lity of men form the fame judgement j 
and particularly when the judgement is 
very different from what the perfon him-? 
felf had before ufaally formed. 

1532. With 



0*F P H Y SIC. T27 

1532. With this miftaken judgement of 
relations there is frequently joined fome 
•falfe perception of external objects, with- 
out any evident fault in the organs of 
fenfe, and which feems therefore to de- 
pend upon an internal caufe ; that is, upon 
the imagination ariiing from a condition 
in the brain prefenting objects which are 
not actually prefent. Such falfe percep- 
tions muft neceffarily occafion a delirium, 
or an erroneous judgement, which is to be 
confidered as the difeafe. 

1533. Another circumftance, common- 
ly attending delirium, is a very unufual 
affociation of ideas. As, with refpect to 
moft of the affairs of common life, the 
ideas laid up in the memory are, in moft 
men, aflbciated in the fame manner; fo 
a very unufual affociation, in any indi- 
vidual muft prevent his forming the ordi- 
nary judgement of thofe relations which 

J 4 are 



128 PRACTICE 

are the moft common foundation of aflb- 
ciation in the memory : and therefore this 
unufual and commonly hurried affociation 
of ideas, ufually is, and may be connder- 
ed as, a part of delirium. Jn particular it 
may be confidered as a certain mark of a 
general morbid affection of the intellec- 
tual organs, it being an interruption or 
preverfion of the ordinary operations of 
memory, the common and necefTary 
foundation of the exercife of judge- 
ment, 

1534. A third circumftance attending 
delirium, is an emotion or paffion, fome- 
times of the angry, fometimes of the 
timid kind ; and from whatever caufe in 
the perception or judgement, it is not 
proportioned to fuch caufe, either in the 
manner formerly cuftomary to the perfon 
himfelf, or in the manner ufual with the* 
generality of other men. 

1535, Delirium, 



OF PHYSIC. 129 

1535. Delirium, then, may be more 
fhortly defined,— In a perfon awake, a 
falfe judgement arifing from perceptions 
of imagination, or from falfe recollection, 
and commonly producing difproportionate 
emotions. 

- Such delirium is of two kinds ; as it is 
combined with pyrexia and comatofe af- 
fections j or, as it is entirely without any 
fuch combination. It is the latter cafe 
that we name Infanity; and it is this kind 
of delirium only that I am to treat of 
here. 

1536. Infanity may perhaps be proper- 
ly confidered as a genus comprehending 
many different fpecies, each of which 
may defer ve our attention;, but before 
proceeding to the confideration of particu- 
lar fpecies, I think it proper to attempt an 

invefligation 



i 3 d PRACTI G E 

inveftigatiori of the caufe of infanity in' 
general. 

1537. In doing: this, I mall take it for 
granted, as demonftrated elfe where, that 
although this difeafe feems to :be chiefly, 
and fometimes folely, an affection of the 
mind ; - yet the connection between the 
mind and body in' this cafe is fuch, that 
thefe affections of the mind inuft be con- 
lidered as depending upon a certain flate 
of our corporeal part. See Halleri Prim. 
Lin. Phyfiolog. § 570. See Boerhaavii Inft. 
Med. §-581. 696. 

1538. Admitting this proportion, I muft 
in the next place aflume another, which 
I likewife fuppofe to be demonftrated 
elfe where. This is, that the part of our 
body more immediately connected with 
the mind, and therefore more efpecially 
concerned in every affection of the intel- 
lectual 



O F P H Y S I C. 131 

ledtual functions, is the common origin 
of the nerves ; which I mail, in what fol- 
lows, fpeak of under the appellation of the 
Brain, 

1539. Here, however, in afTuming this 
lad proportion, a very great difficulty 
immediately prefents itfelf. Although we 
cannot doubt that the operations of our 
intellect always depend upon certain mo- 
tions taking place in the brain, (fee Gaub. 
Path. Med. § 523) ; yet thefe motions 
have never been the objects of our fenfes, 
nor have we been able to perceive that 
any particular part of the brain has more 
concern in the operations of our intellect 
than any other. Neither have we attain- 
ed any knowledge of what fhare the fe~ 
veral parts of the brain have in that ope- 
ration ; and therefore, in this fituation of 
our fcience, it muft be a very difficult 
matter to difcover thofe ftates of the 

brain 



i 3 2 PRACTICE 

brain that may give occafion to the 
various ftate of our intellectual func- 
tions. 

1540. It may be obferved, that the dif- 
ferent flate of the motion of the blood 
in the velfels of the brain has fome fhare 
in affecting the operations of the intel- 
lect; and phyficians, in feeking for the 
caufes of the different ftates of our in- 
tellectual functions, ,. have hardly looked 
farther than into the ftate of the motion 
of the blood, or into the condition of the 
blood itfelf : but it is evident that the o- 
perations of the intellectual functions or- 
dinarily go on, and are often considera- 
bly varied, without our being able to per- 
ceive any difference either in the motions 
or in the conditions of the blood. 

1 541. Upon the other hand, it is ve- 
ry probable tjiat the ftate of the intellec- 
tual 



O F P H Y S I C. 13- 

tual functions depends chiefly upon the 
ftate and condition of what is termed 
the Nervous Power, or, as we fuppofe, of 
a fubtile very moveable iluid, included or 
inherent, in a manner we do not clearly 
underftand, in every part of the medul- 
lary • fubftance of the brain and nerves, 
and which in a living and healthy maa 
is capable of being moved from every 
one part to every other of the nervous 
fyftem„ 

1542. With refpedl to this power, we 
have pretty clear proof that it frequent- 
ly ,has a motion from the" fentient extre*- 
mities of the nerves towards the brainy 
and thereby produces fenfation ; and we 
have the fame proof, that in confequence 
of volition the nervous power has a mo- 
tion from the brain into the mufcles or 
organs of motion* Accordingly, as fen^ 
fiition excites our intellectual • operations, 

and. 



i 3 4 • PRACTICE 

and volition is the effect of thefe, and 
as the connection between fenfation and 
volition is always by the intervention of 
the brain and of intellectual operations; 
fo we can hardly doubt, that thefe latter 
depend upon certain motions, and the 
various modifications of thefe motions in 
the brain. 

1543. ^° afqertain the different flates 
of thefe motions may be very difficult ^ 
and phyficians have commonly confider- 
ed it to be fo very myfterious, that they 
have generally defpaired of attaining any 
knowledge with regard to it : but I con- 
fider fuch abfolute defpair, and the negli- 
gence it infpires, to be always very 
blameable j and I mall now venture to 
go fome length in the inquiry, hoping 
that fome (leps made with tolerable 
firmnefs may enable us to go flill fur- 
ther. 

r T544. To 



OF PH Y S rc. 155: 

1544. To this purpofe,. I think it evi- 
dent, that the nervous power, in the whole 
as well as in the feveral parts of the ner- 
vous fyfterttj and particularly in the 
brain, is at different times in different 
degrees of mobility and force. To thefe 
different ftates, I beg leave to apply the 
terms of Excitement and Collapfe. To 
that flate in which the mobility and force 
are fufficient for the exercife of the func- 
tions, or when thefe ftates are- any way 
preternaturally increafed, I give the name 
of Excitement; and to that flate in winch 
the mobility and force are not fufficient' 
for the ordinary exercife of the functions, 
or when they are diminimed from the 
ftate in which they had been before, I' 
give the name of Collapfe. I beg, howe- 
ver, it may be obferved, that by thefe 
terms I mean to express matters of fact 
only ; and without intending, by thefe 
terms, to explain the circumftance or 

condi tiony 



136 P R AC T I C E 

condition, mechanical or phyfical, of 
the nervous power or fluid in thefe diffe- 
rent ftates. 

1545. That thefe different ftates of 
excitement and collapfe take place on dif- 
ferent occafions, muft, I think, be mani- 
feft from numberlefs phenomena of the 
animal ceconomy : but it is efpecially to 
our prefent purpofe to obferve, that the 
different ftates of excitement and collapfe, 
are in no inftance more remarkable, than 
in the different ftates of waking and 
fleeping. In this latter, when quite com- 
plete, the motion and mobility of the 
nervous power, with refpecf to the whole 
of what we called the Animal Functions-, 
entirely ceafe, or, as I would exprefs it, 
are in a ftate of collapfe : and are very 
different from the ftate of waking, which 
in healthy perfons I would call a ftate of 
general and entire excitement. 

1546. This 



O F P H Y S I C. 137 

X546. This difference in the dates of 
the nervous power in fleeping and wak- 
ing being admitted, I muft in the next 
place obferve, that when thefe dates are 
changed from the one into the other, as 
commonly happens every day, the change 
is hardly ever made infta-ntaneoufly, but 
almoft always by degrees, and in fome 
length of time only : and this may be 
obferyed with refpedJ to both fenfe and 
motion. Thus when a perfon is falling 
afleep, the fenfibility is gradually dimi- 
nifhed : fo that, although fome degree of 
fleep has come on, flight impreffions will 
excite fenfation, and bring back excite- 
ment ; which the fame, or even ftronger, 
impreffions, will be inefficient to pro- 
duce when the ftate of fleep has continu- 
ed longer, and is,, as we may fay, more 
complete. In like manner, the power of 
voluntary motion is gradually diminifhed. 
In fome members it fails fooner than in 

Vol. IV. K others; 



138 PRACTICE 

», 
others ; and it isfome time before it becomes 

general and confiderable over the whole* 

The fame gradual progrefs may be re- 
marked in a perfon's coming out of fleep : 
The ears in this cafe are often awake be- 
fore the eyes are opened to fee clearly, 
and the fenfes are often awake before 
the power of voluntary motion .is re- 
covered j and it is curious to obferve, that 
in fome cafes, fenfations may be excited 
without producing the ordinary affociaT 
tion of ideas. See Mem. de Berlin. 1752. 

1547. From all this, I think it will 
clearly appear, that not only the different 
dates of excitement and collapfe can take 
place in different degrees, but that they 
can take place in different parts of the 
brain, or at leaft, with refpecl to the difr 
ferent functions, in different degrees. - 

A&Iprefume that almoft every perfon 

* . has 



OF P H Y S I d 139 

has perceived the gradual approach of 
fleeping and waking, I likewife fuppofe 
every perfon has obferved, that, in fuch 
intermediate ftate of unequal excitement, 
there almoft always recurs more or lefs 
of delirium, or dreaming, if any body 
choofes to call it {o. There are in this 
ftate falfe perceptions^ falfe aflbciations, 
falfe judgements, and difproportionate e- 
motions ; in fhbrt, all the circumftances 
by which I have above defined delirium* 

This clearly mows that delirium may 
depend, and I fhall hereafter endeavour 
to prove that it commonly does depend, 
upon fome inequality in the excitement 
of the brain ; and that both thefe affer- 
tions are founded on this, that, in order 
to the proper exercife of our intellectual 
functions, the excitement muft be com- 
plete, and equal in every part of the 
brain. For though we cannot fay that 
K 2 the 



140 



PRACTICE 



the veftiges of ideas are laid up in different 
parts of the brain, or that they are in 
fome meafure diffufed over the whole, it 
will follow upon either fuppofition, that 
as our reafoning and our intellectual 0- 
perations always require the orderly and 
exact recollection or memory of affociated 
ideas; fo, if any part of the brain is not 
excited, or not excitable, that recollection 
cannot properly take place, while at the 
fame time other parts of the brain, more 
excited and excitable, may give falfe 
perceptions, alTociations, and judgements* 

1548. It will ferve to illuftrate this, 
that the collapfe in fleep is more or 
lefs complete ; or that the fleep, as we 
commonly fpeak, is more or lefs pro- 
found : and therefore, that in many caf- 
es, though fleep takes place to a confide- 
rable degree, yet certain impreilions do 
ftill take effect, and excite motions, 

or, 



O F P H Y S I C. 141 

or, if you will, fenfations in the brain ; 
but which fenfations, upon account of the 
collapfed ftate of fo great a part of the 
brain, are generally of the delirious kind, 
or dreams, confiding of falfe perceptions, 
aflbciations, and judgements, that would 
have been corrected if the brain had been 
entirely excited. 

Every one, I believe, has obferved, 
that the moft imperfect fleeps are thofe 
chiefly attended with dreaming •> that 
dreams, therefore, moft commonly occur, 
towards morning, when the complete ftate 
of fleep is palling away ; and further, that 
dreams are moft commonly excited by 
ftrong and uneafy impreffions made upon 
the body. 

I apprehend it may alfo be an illuftra- 
tion of the fame thing, that, even in wak- 
ing hours, we have an inftance of an une- 
K 3 qua! 



i 4 2 PRACTICE 

qual ftate of excitement in the brain pro^. 
ducing delirium. Such, I think, occurs 
in the cafe of fever. In this, it is mani- 
fest, that the energy of the brain, or its 
excitement, is confiderably diminifhed 
with refpecl to the animal functions; 
and it is accordingly upon this ground 
that I have explained above (in 45,) the 
delirium which fo commonly attends fe- 
ver. To what I have there faid, I fhall 
here only add, that it may ferve to con? 
firm my doctrine, that the delirium in 
fever comes on at a certain period of the 
difeafe only, and that we can commonly 
difcern its approach by a more than ufual 
degree of it appearing in the time of the 
patient's falling into or coming out of 
fleep. It appears, therefore, that delirium 
when it firft comes on in fever, depends 
upon an inequality of excitement ; and it 
can hardly be doubted, that the delirium 
which comes at length to prevail in the 

entirely 



© F P'HYS'I C 143 

entirely weakened ftate of fevers, depends 
upon the fame caufe prevailing in a more 
considerable degree. 

1549. From what has been now deli- 
vered, I hope it will be fufficiently evi- 
dent, that delirium may be, and fre- 
quently is, occaiioned by an inequality in 
the excitement of the brain. 

How the different portions of the brain 
may at the fame time be excited or collap- 
fed in different degrees, or how the ener- 
gy of the brain may be in different degrees 
of force, with refpeel to the feveral animal, 
vital, and natural functions, I cannot pre- 
tend to explain ; but it is fufficiently evi- 
dent in fact, that the brain may be at one 
^nd the fame time in different conditions 
with refpect to thefe functions. Thus in 
inflammatory difeafes when, by a ftimu- 
lus applied to the brain, the force of the 
K. 4 vitei 



H4 PRACTICE 

vital functions is preternaturally increafed, 
that of the animal is either little changed, 
or confiderably diminimed. On the con- 
trary, in many cafes of, mania, the force 
of the animal fundions depending always 
on the brain, is prodigioufly increafed, 
while the ftate of the vital fundion in 
the heart is very little or not at all changr 
ed. I muft therefore fay again, that how 
difficult foever it may be to explain the 
mechanical or phyfical condition of the 
brain in fiich cafes, the fads are fuf- 
ficient to mow that there is fuch an ine- 
quality as may difturb our intellectual 
operations. 

1550. I have thus endeavoured to ex* 
plain the general caufe of Delirium: which 
is of two kinds ; according as it is with 
or without pyrexia. Of the fir ft I take 
no further notice here, having explained 
it as well as I could above (in 45). 

3 I 



OF PHYSIC. 145 

I proceed now to confider that delirium 
which properly belongs to the clafs of Ve- 
faniae, and which I fhall treat of under 
the general title of Infanity. 

1 55 1. In entering upon this fubject, it 
immediately occurs, that in many in- 
ftances of infanity, we find, upon direc- 
tion after death, that peculiar circumftan- 
ces had taken place in the general condi- 
tion of the brain. In many cafes, it has 
been found of a drier, harder, and firmer 
confiftence, than what it is ufually of in 
perfons who had not been affected with 
that difeafe. In other cafes, it has been 
found in a more humid, foft, and flaccid 
ftate; and in the obferyations of the late 
Mr Meckel*, it has been found confider- 

ably 

* Memoirs de Berlin pour l'annee 1764. It appeared 
in many inftances of infane perfons, that the medullary 

fubilance 



x 4 5 PRACTICE 

ably changed in its denfity or fpecific gra- 
vity. Whether thefe different ftates have 
been obferved to be uniformly the fame 
over the whole of tire brain, I cannot cer- 
tainly learn ; and I fufpect the diffectors 
have not always accurately inquired into 
this circumftance : but in feveral instan- 
ces, it appears that thefe ftates had 
been different in different parts of the 
brain ; and inftances of this inequality 
will afford a confirmation of our general 
doctrine. 

The accurate Morgagni has obferved, 
that in maniacal perfons the medullary 
portion of the brain is unufually dry, 
hard, and firm : And this he had fo fre- 
quently obferved, that he was difpofed to 

confider - 



fubftance of the cerebrum was drier, and of a lefs fpa- 
eific gravity, than in perfons who had been always of a 
found judgement. Author, 



OF PHYSIC i 47 

confider it as generally the cafe. But in 
moft of the particular inftances which 
he has given, it appears, that, for the 
moft part, while the "cerebrum was of an 
unufually hard and firm confidence, the 
cerebellum was of its ufual foftnefs ; and 
in many of the cafes it was unufually foft 
and flaccid. In fome other cafes, Mor- 
gagni obferves, that while a part of the 
cerebrum was harder and firmer than or- 
dinary, other parts of it were preternatu- 
rally foft. 

1552. Thefe obfervations tend to con- 
firm our general doctrine : and there are 
others which I think will apply to the 
fame purpofe. 

Upon the difTection of the bodies of 
perfons who had laboured under infanity, 
various organic affections, have been dis- 
covered in particular parts of the brain ; 

and 



148 PRACTICE 

and it is fufficiently probable, that fuch 
organic affections might have produced 
a different degree of excitement in the free- 
and affected parts, and muft have inter- 
rupted in fome meafure the free com- 
munication between the feveral parts of 
the brain, and in either way have occafion- 
ed infanity. , 

There have occurred Co many inftances 
of this kind, that I believe phyficians are 
generally difpofed to fufpecl organic le- 
fions of the brain to exift in almoft every 
cafe of infanity. 

1553. This, however, is; probably a 
miftake ; for we know that there have 
been many inftances of infanity from 
which the perfons haye entirely recover- 
ed j and it is difficult to fuppofe that any 
organic lefions of the brain had in fuch 
qafe taken place. Such tranfitory cafes, 

indeed, 



O F P H Y S I C. 149 

indeed, render it probable, that a ftate of 
excitement, changeable by various caufes, 
had been the caufe of fuch inftances of 
infanity. 

1554. It is indeed further afTerted, that 
in many inftances of infane perfons, their 
brain had been examined after death, 
without mowing that any organic lefions 
had before fubfifted in the brain, or find- 
ing that any morbid ftate of the brain 
then appeared. This, no doubt, may ferve 
to fhow, that organic lefions had not been 
the caufe of the difeafe ; but it does not 
affure us that no morbid change had taken 
place in the brain : for it is probable, that 
the diffectors were not always aware of its 
being the general condition of hardneis 
and denGty, as different in different parts 
of the brain that was to be attended to, 
in order to difcover the caufe of the pre- 
ceding difeafe ; and' therefore many of 

them 



t$6 PRACTICE 

them had not with this view examined thd 
flate of the brain, as Morgagni feems 
carefully to have done* 

1 555. Having thus endeavoured to in- 
vestigate the caufe of infanity in general 
it were to be wifhed that I could apply 
the doctrine to the diftinguifhing the fe* 
veral fpecies of it, according as they de- 
pend upon the. different ftate and circum- 
ftances of the brain, and thereby to the 
eftablifhing of a fcientific and accurately 
adapted method of cure. Thefe purpofes, 
however, appear to me to be extremely 
difficult to be attained ; and I cannot 
hope to execute them here. All I can do 
is to make fome attempts, and offer fome 
reflections, y^hich further obfervation, and 
greater fagacity, may hereafter render 
more ufeful. 

1556. The 



• of rHYSia i ft 

1556* The ingenious Dr Arnold has 

r 

been commendably employed in diftin- 
guilhing the different fpecies of infanity 
as they appear with refpect to .the mind; 
and his labours may hereafter prove ufe^- 
ful, when we fhall come to know fome* 
thing more of the different ftates of the 
brain correfponding to thefe different 
ftates of the mind; but at prefent I can 
make little application of his numerous 
diftinctions. It appears to me that he ha* 
chiefly pointed out and enumerated dif- 
tinclions, that are merely varieties,, which 
can lead? to little or no variety of practice : 
and I am efpecially led to form the latter 
conclufion, becaufe thefe varieties appear 
to me to be often combined together, and 
to be often changed into one another, in 
the fame perfon j in whom we muft 
therefore fuppofe a general caufe of the 
difeafe, which, fo far as it can be known, 

muft. 



15,2 PRACTICE 

muft eftablifh the pathology, and efpeci- 
ally direct the practice. 

1557. In my limited views of the dif- 
ferent ftates of infanity, I muft go on to 
confider them under the two heads of 
Mania and Melancholia : and though I 
am fenfible that thefe two genera do not 
comprehend the whole of the fpecies 
of infanity, I am not clear in aligning 
the other fpecies which may not be com- 
prehended under thofe titles. I ifhallj 
however, endeavour, on proper occafions 
as I go along, to point them out as well 
as 1 can. 



CHAP. 



OF PHYSIC. 1 5j 



CHAP. II, 



OF. 



M A N I A, 



OR 



MADNESS. 



1 55%- * I ''HE circumftances which I have 

mentioned above in 1535, as 

conflituting delirium in general, do more 

efpecially belong to that kind of it which 

Vol. IV. L I 



i$4 PRACTI C'E 

I jfliall treat of here under the title of 
Mania. 

There is fometimes a falfe perception or 
imagination of things prefent that are 
not; but this is not a conftant, nor even 
a frequent, attendant of the difeafe. The 
falfe judgement, is of relations long before 
laid up in the memory. It very often turns 
upon one fingle fubject: but more com- 
monly the mind rambles from one fubject 
to another with an equally falfe j udgement 
concerning the mod part of them j and as 
at the fame time there is commonly a falfe 
affociatioQ, this increafes the confufion of 
ideas, and therefore the falfe judgements. 
What for the moft part more efpecially dif- 
tinguifhes the difeafe is a hurry of mind, 
in purfuing any thing like a train of 
thought, and in running from one train of 
thought to another. Maniacal perfons 
are in, general very irafcible; but what 

more 



OF. PHYSIC. 155 

more particularly produces their angry- 
emotions is, that their falfe judgements 
lead to Tome action which. is always pufh- 
ed with impetuofity and violence ; when 
this is interrupted or reftrained,, they 
break out into violent anger and furious 
violence againft every perfon near them, 
and upon every thing that ftands in the 
way of their impetuous will. The falfe 
judgement often turns upon a miftaken 
opinion of fome injury fuppofed to have 
been formerly received, or now fuppofed. 
to be intended : and it is remarkable, 
that fuch an opinion is often with refpect 
to their former dearefl friends and re- 
lations ; and therefore their refentmenr. 
and anger are particularly directed towards 
thefe. And although this fhould not be 
the cafe, they Commonly foon lofe that 
refpect and regard which they formerly 
had for their friends and relations. With 
all thefe circumftances, it will be readily 
L 2* perceived, 



*56 PRACTICE 

perceived, that the dife*afe muft be attend- 
ed very conftantly with that incoherent 
and abfurd fpeech we call raving. Fur- 
ther, with the circumftances mentioned, 
there is commonly joined an unufual 
force in all the voluntary motions,; and 
an infenfibility or refiftance of the force 
of all impreffions, and particularly a re- 
fiftance of the powers of fleep, of cold, 
and even of hunger ; though indeed in 
many inftances a voracious appetite takes 
place. 

1559. It appears to me, that the whole 
of thefe circumftances and fymptoms point 
out a confiderable and unufual excefs 
in the excitement of the brain, efpecially 
with refpect to the animal functions ; and 
it appears at the fame time to be mani- 
feftly in fome meafure unequal, as it very 
often takes place with refpecT: to thefe 
fun&ions alone, while at the fame time 

the 



OF PHYSIC. 157 

the vital and natural are commonly^very 
little changed from their ordinary heal- 
thy (late. 

1560. How this excefs of excitement is 
produced, it may be difficult to explain. 
In the various inftances of what Sauvages 
has named tjie Mania Metajlatica^ and in 
all the inftances I have mentioned in my 
Nofology under the title of Mania Corpo- 
rea y it may be fuppofed that a morbid 
organic affection is produced in fome 
part of the brain ; and how that may pro- 
duce an increafed or unequal excitement 
in certain parts of it, I have endeavour- 
ed to explain above in 1552. But I 
mud at the fame time acknowledge, that 
fuch remote caufes of mania have ve- 
ry rarely occurred ; and that therefore 
fome other caufes of the difeafe mud be 
fought for. 

L 3 The 



158 PRACTICE 

The effects of violent emotions or paf- 
fions of the mind have more frequently- 
occurred as the remote caufes of Mania ; 
and it is fufficiently probable, that fuch 
violent emotions, as they do often imme- 
diately produce a temporary increafe of 
excitement, fo they may, upon fome oc- 
cafions of their permanent inherence or 
frequent repetition, produce a more con- 
fiderable and more permanent excitement, 
that is, a mania. 

With refpect to thofe caufes of mania 
which arife in confequence of a melan- 
cholia^ which had previoufly long fubfift- 
ed ; whether we confider that melancho- 
lia as a partial infinity, or as a long per- 
illing attachment to one train of think- 
ing, it will be readily perceived, that in 
either cafe fuch an increafe of excitement 
may take place in fo confiderable a de- 
gree, and in fo large a portion of the 

\ brain, 



OF PHYSIC. 159 

brain, as may give occafion to a complete 
mania. 

1 561. Thefe confiderations with regard 
to the remote caufes appear to me to con- 
firm fufficiently our general doctrine of 
increafed and unequal excitement in the 
mania which I have defcribed above; 
but I mud own that I have not exhaufted* 
the fubject, and that there are cafes of 
mania of which I cannot affign the re- 
mote caufes : but although I cannot in all 
cafes explain in what manner the mania 
is produced, I prefume from the explana- 
tion given, and efpeoially from the fymp- 
toms enumerated above, to conclude, that 
the difeafe defcribed above depends upon 
an increafed excitement of the brain ; an 
opinion in which I am the more confirm- 
ed, as I think it will point out the proper 
method of Cure. At lead I think it will 
mod clearly explain the operation of thofe 
L 4 remedies, 



i6o PRACTICE 

remedies, which, fo far as I can learn 
from my own experience and that of 
others, have proved the mod fuGcefsful 
in this difeafe ; and to illuftrate this, . I 
now enter upon the confideration of thefe 
remedies, and to make fome remarks, 
upon the proper manner of employing 
them. 

1562. Reftraining the anger and vior 
lence of madmen is always neceffary for 
preventing their hurting themfelves or 
others : but this reftraint is alio to be 
confidered as a remedy. Angry paftions 
are always rendered more violent by the 
indulgence of the impetuous motions 
they produce; and even in madmen the 
feeling of reftraint will fometimes pre-* 
vent the efforts which their paflion 
"would otherwife occafion. Reftraint, 
therefore, is ufeful, and ought to be 
complete ; but it fhould be executed in 

the 



- O F P H Y S I C. 161 

the eafieft manner poflible for the patient, 
and the ftrait waiftcoat anfwers every 
purpofe better than any other that has 
yet been thought of. The reftraining 
madmen by the force of other men, as 
occafioning a conftant ftruggle and vio- 
lent agitation, is often hurtful. Although 
on many occafions, it may not be fafe 
to allow maniacs to be upon their legs or 
to walk about, it is never de Arable to 
confine them to a horizontal fituation ; 
and whenever it can be admitted, they 
fhould be more or lefs in an erect pofture. 
Although there may be no fymptoms of 
any preternatural fulnefs or increafed im- 
petus of blood in the veffels of the brain, 
a horizontal pofture always increafes the 
fulnefs and tenfion of thefe veffels, and 
may thereby increafe the excitement of 
the brain. 

1563. The reftraint mentioned requires 

confinement; 



ifo PRACTICE 

confinement within doors, and it -mould 
be in a place which prefents as few objects 
of fight and hearing as poflible ; and par- 
ticularly, it mould be removed from the 
objects that the patient was formerly 
acquainted with, as thefe would more 
readily call up ideas and their various af- 
fociations. It is for this reajfon that the 
confinement of madmen fhould hardly 
ever be in their ufual habitation ; or if 
they are, that their' apartments mould be 
ftripped of all its former furniture. It is 
alfb for the mofl part proper, that, ma- 
niacs fhouldr be without the company of 
any of their former acquaintance ; the 
appearance of whom commonly excites 
emotions that increafe the difeafe. Stran- 
gers may at firft be ofFenfive ; but in 
a little time they come to be objects ei- 
ther of indifference or of fear, and they 
mould not be frequently changed. 

1564. Fear 



O F P H Y S I C. 163 

s 1564. Fear being a paffion that dimi- 
niflies excitement, may therefore be op- 
pofed to the excefs of it ; and particularly 
to the angry and irafcible excitement of 
maniacs. T-hefe being moVe fufceptible 
of fear than might be expected, it appears 
to me to have been commonly ufeful. In- 
moft cafes it has appeared to be neceffary 
to employ a very conflant impreflion of 
fear ; and therefore to infpire them with 
the awe and dread of fome particular 
perfons, efpecially of thofe who are to be 
conftantly near them. This awe and 
dread is therefore, by one means or other, 
to be acquired ; in the firft place, by their 
being the authors of all the reftraints that 
may be occafionally proper; but fome=- 
times it may be n«ce{Tary to acquire it e- 
ven by ftripes and blows. The for- 
mer, although having the appearance of 
more feverity, are much fafer than ftrokes 
or blows about the head. Neither of 

them, 



1 54 - PRACTICE 

them, however, mould be employed fur- 
tier than feems very necefTary, and mould 
be trufted to thole only whofe difcretion 
can^ be depended upon. There is one 
cafe in which they are fuperfluous ; that 
is, when the maniacal rage is either not 
fufceptible of fear, or incapable of re- 
membering the objects of it; for in fuch 
instances, ftripes and blows would be 
wanton barbarity. In many cafes of a 
moderate difeafe, it is of advantage that 
the perfbns who are the authors of re- 
ftraints and punifhment mould be upon 
other occanons the beftowers of every in- 
dulgence and gratification that is admif- 
iible j never, however, neglecting to em- 
ploy their awe when their indulgence 
ihall have led to any abufe. 

1565. Although in mania, no particu- 
lar irritation nor fulnefs of the fyitem 
feem to be prefent, it is plain that the 

avoiding 



OF PHYSIC. 165 

avoiding of all irritation and means of ful- 
nefs is proper ; and therefore, that a diet 
neither flimulating nor nourishing is 
commonly to be employed. As it may 
even be ufeful to diminifh the fulnefs 
of the fyftem, fo both a low and a 
fpare diet is likely in mod cafes to be of 
fervice. 

1566. Upon the fame principle, al- 
though no unufual fulnefs of the body 
be prefent, it may be of advantage to di- 
minifh even its ordinary fulnefs by diffe- 
rent evacuations. 

Blood-letting, in particular, might be 
fuppofed ufeful; and in all recent cafes 
of mania it has been commonly practifed^ 
and I think with advantage ; but when 
the difeafe has fubfifted, for fome time, 
I have feldom found blood-letting of fer- 
vice. In thofe inftances in which there 

is 



im PRA.CTI CE 

is any frequency or fulnefs of pulfe, of 
any marks of an increafed impetus of the 
blood in the vefTels of the head, blood-let- 
ting is a proper and even a neceffary re- 
medy • Some practitioners, in fuch cafes, 
have preferred a particular manner of 
blood-letting, recommending ateriotomy, 
fcarifyrjng the hind-head, .or opening the 
jugular vein j and- where any fulnefs or 
inflammatory difpofition in the vefTels of 
the brain is to be fufpetfted, the opening 
of the vefle.ls neareft to them is likely to 
be of the greatefl fervice. , The opening, 
however, of either the temporal artery 
or the jugular vein in maniacal perfons 
is very often, inconvenient ; and it may 
generally' be fufficient to open a vein in 
the arm, while the body is kept fomewhat 
of an erect poflure, and fuch a quantity 
of blood drawn as nearly brings on a 
deliquium animi, which is always a pret- 
ty certain mark of fome diminution of 

the 



O F P H Y S I C. 167 

the fulnefs and tenfion of the vefTels of 
the brain. 

1567. For the fame purpofe of taking 
ofFthe fulnefs and tenfion of thefe vefTels 
of the brain, purging may be employed; 
and I can in no other view underftand 
the celebrated ufe of hellebore among 
the ancients, I cannot, however, fuppofe 
any fpecific power in hellebore ; and can 
by no means find, that at leafl the black 
hellebore, is fo efficacious with us as it is 
faid to have been at Anticyra. As cof- 
tivenefs, however, is commonly a very 
conftant and hurtful attendant of mania, 
purgatives come to be fometimes very 
neceffary: and I have known fome be- 
nefit obtained from the frequent ufe of 
pretty draflic purgatives. In this, how- 
ever, I have been frequently difappoint- 
ed ; and I have found more advantage 
from the frequent ufe of cooling purga- 
1 tives. 



1 68 PRACTICE 

tives, particularly the foluble tartar, than 
from more draftic medicines, 

1568. Vomiting has alfo been frequent- 
ly employed in mania j and by deter- 
mining powerfully to the furface of 
the body, it may poflibly diminiih the 
fulnefs and tenfion of the vefTels, and 
thereby the excitement of the brain ; but 
I have never carried the ufe of this reme- 
dy fo far as might enable me to judge 
properly of its effects. Whether it rnay 
do harm by impelling the blood too for- 
cibly into the vefTels of the brain, or 
whether by its general agitation of the 
whole fyftem, it may remove that ine- 
quality of excitement which prevails in 
mania, I have not had experience enough 
to determine. 

1569. Frequent {having of the head 
has been found of fervice in mania, and 

by 



OF PHYSIC. 169 

by promoting perfpiration, it probably 
takes off from the excitement of the in- 
ternal parts. This, however, it is like- 
ly, may be more effectually done by 
bliftering, which more certainly takes off 
the excitement of fubjacent parts. In 
recent cafes it has been found ufeful 
by inducing fleep ; and when it has that 
effect, the repetition of it may be pro- 
per : but in maniacal cafes , that have 
lafted for fome time} bliftering has not 
appeared to me to be of any fervice ; and 
in fuch cafes alfo I have not found per- 
petual blifters, or any other form of if- 
fue, prove ufeful. 

1570. As heat is the principal means 
of firft exciting the nervous fyftem, and 
eftabliihing the nervous power and vital 
principal in animals ; fo, in cafes of pre- 
ternatural .excitement, the application of 
cold might be fuppofed a remedy; but 

Vol. IV. M there 



17? PRACTICE 

there are many inflances of maniacs who 
have been expofed for a great length of 
time to a confiderable degree of cold with- 
out having their fymptoms anywife re- 
lieved. This may render in general the 
application of cold a doubtful remedy ; 
but it is at the fame time certain, that 
maniacs have often been relieved, and 
iometimes entirely cured, by the ufe of 
cold-bathing, efpecially when administer- 
ed in a certain manner. This feems to 
confift, in throwing ~ the madman into 
cold water by furprife ; by detaining him 
in it for fome length of time ; and pour* 
, ing water frequently upon the head, while 
the whole of the body except the head is 
immerfed in the water ; and thus manag- 
ing the whole procefs, fo as that, with 
the aiTiftance of fome fear, a refrigerant 
effect may he produced. This, I can af- 
firm, has been often ufeful ; and that the 
external application of cold may be of 
3 fervice, 



OF PHYSIC. 171 

fervice, we know further from the . bene- 
fit which has been received in fome ma- 
niacal cafes from the application of ice 
and fnow to the naked head, and from 
the application of the noted Clay Cap. 

Warm bathing has been alfo recom- 
mended by fome practical writers ; and 
in rigid melancholic habits it may pofli- 
bly be ufeful, or as employed in the 
manner prefcribed by fome, of immerfing 
the lower parts of the body in warm wa- 
ter, while cold water is poured upon the 
head and upper parts. Of this practice^ 
however, I have had no experience ; and 
in the common manner of employing 
warm bathing I have found it rather hurt- 
ful to maniacs. 

157 1. According to my fuppofition 
that the difeafe depends upon an increas- 
ed excitement of the brain, efpecially with 
M 2 refpect 



172 PRACTICE 

refpedl to the animal functions, opium, fa 
commonly powerful in inducing ileep, or 
a confiderable collapfe as to thefe func- 
tions, mould be a powerful remedy of 
mania. That it has truly proved fuch, I 
believe from the teftimony of Bernard 
Huet* whofe practice is narrated at the 
end of Wepferi Hiftorra Apoplecticorum, 
I leave to my readers to ftudy this in the 
work I have referred to, where every 
part of the practice is fully, and as it ap* 
pears to me,, very judiciouGy delivered. I 
have never indeed carried the trial Co far 
as feems to be requisite to an entire cure : 
but I have frequently employed in fome 
maniacal cafes large dofes of opium ; and 
when they had the efFecT: of inducing 
Ileep, it' was manifestly with advantage. 
At the fame time, in fome cafes, from 
doubts, whether the difeafe .might not 
depend upon fome organic lefions of the 
brainj when the opium would be fuper- 
fc jSuous^ 



O F P H Y S I C. 173 

fluous ; and in other cafes, from doubts, 
whether there might not be fome in- 
flammatory affection joined with the 
mania, when the opium would be hurt- 
ful, I have never pufhed this remedy to 
the extent that might be necefTary to make 
an entire cure. 

1572. Camphire has been recommend- 
ed as a remedy of mania, and there are 
inftances alledged. of its having perform- 
ed an entire cure. As it" appears from 
the experiments of Beccaria that this 
fubftance is pofTefTed of a fedative and 
narcotic virtue, thefe cures are not alto- 
gether improbable: but in feveral trials, 
and even in large dofes, I have found no 
benefit from it; and excepting thofe in 
the Philofophical Tranfaaions, No. 400. 
I have hardly met with any other teftimo- 
nies in its favour. 

M 3 1573. I 



174 PRACTICE 

1573. I have been informed that fome 
maniacs have been" cured by being com- 
pelled to conftant and even hard labour ; 
and as a forced attention to the conduct 
of any bodily exercife is a very certain 
means of diverting the mind from purfu- 
ing any train of thought, it is highly pro- 
bable that fuch exercife may be ufeful 
in many cafes of mania. 

I muft conclude this fubject with ob- 
ferving, that even in feveral cafes of com- 
plete mania I have known a cure take 
place in the courfe of .a journey carried 
on for fome length of time. 

1574; Thefe are the remedies which 
have been chiefly employed in the ma- 
nia that has been above defcribed, and 1 
believe that they have been employed 
promifcuoufly, without fuppofing that the 
mania was to be diftinguifhed into diffe- 
rent 



OF PHYSIC. 175 

rent fpecies. Indeed I am not ready to 
fay how far it is to be fo diftinguifhed, 
but I mall offer one obfervation which 
may poffibly merit attention. 

It appears to me that there are two 
different cafes of mania that are efpecially 
different according to the original tempe- 
rament of the perfons whom the dif- 
eafe affects. It perhaps occurs moft fre- 
quently in perfons of a melancholic or 
atrabilarian temperament ; but it certain- 
ly does alfo often occur in perfons of that 
very oppofite temperament which phyfi- 
cians have named the Sanguine. Ac- 
cording as the difeafe happens to occur 
in perfons of the one or other of thefe 
temperaments, I -apprehend it may be 
confidered as of a different nature ; and 
I believe, that accurate obfervation, em- 
ployed upon a fufficient number of cafes, 
would difcern fome pretty conftant diffe- 
M 4 rence, 



M76 PRACTICE 

rence, either of the fymptoms, or at leaft 
of- the ftate of the fymptoms, in the two 
cafes. I imagine- that falfe imaginations, 
particular aversions and refentments, are 
more fixed and fteady in the melancholic 
than in the fanguine j and that fomewhat 
inflammatory is more commonly joined, 
with mania in the fanguine than in the 
* melancholic. If fuch difference^ how- 
ever, does truly take place, it will be ob- 
vious, that it may be proper to make 
fome difference alfo in the practice. \ 
am of opinion, that in the mania of fanr 
guine perfons, blood-letting and other 
antiphlogiftic meafures are more proper, 
and have been more ufeful, than in the 
melancholic. I likewife apprehend that 
cold bathing is more ufeful in the fan- 
guine than in the melancholic : but I 
have not had experience enough to afcer- 
, tain thefe points with fufficient confi- 
dence. 

I 



OF PHYSIC. 177 

I have only to add to this other obfer- 
nation, that maniacs of the fanguine tem- 
perament recover more frequently and 
more entirely than thofe of the melan- 
cholic. 



C H A P. 



178 PRACTICE 



CHAP. in. 



©F 



MELANC HO L Y, 



AND 



OTHER FORMS OF INSANITY. 



1575* T^yf Elan c holy has been com- 
AtX monly ' confidered as par- 
tial infanity ; and as fuch it is defined in 
my Nofology : but I now entertain doubts 

if 



O F P H Y S I C. 179 

if this be altogether proper. By a partial 
infanity, I underftand a falfe and mi (ta- 
ken judgement upon one particular fub- 
ject, and what relates to it; whilft, on 
every other fubje&, the perfon judges as 
the generality of other men do. Such 
cafes have certainly occurred ;^but, I be- 
lieve, few in which the partial infanity 
is certainly limited. In many cafes of 
general infanity, there is one fubjed of 
anger or fear, upon which the falfe judge- 
ment more particularly turns, or which 
is at leaft more frequently than any 
other the prevailing object of delirium : 
and though, from the inconfiftency which 
this principal object ' of delirium muft 
produce, there is therefore alfo a great 
deal of infanity with regard to moll 
other objects ; yet this laft is in very dif- 
ferent degrees, both in different perfons, 
and in the fame perfon at different times. 
Thus perfons confidered as generally in- 

fane, 



i8o PRACTICE 

fane, will, however, at times, and in 
fome cafes, pretty conftantly judge pro- 
perly enough of prefent circumftances 
and incidental occurrences j though, when 
thefe objects engaging attention are not 
prefented, the operations of imagination 
may readily bring back a general confu- 
(ion, or recal the particular object of the 
delirium. From thefe confiderations, I am 
inclined to conclude, that the limits be- 
tween general and partial infanity cannot 
always be fo exactly affigned, as to deter- 
mine when the partial affection is to be 
confidered as giving a peculiar fpecies of 
difeafe, different from a more general in- 
fanity. 

1576. When infanity neither flrictly 
partial, nor entirely nor conftantly general, 
occurs in perfons of a fanguine tempera- 
ment, and is attended with agreeable^ 
rather than with angry or gloomy emo- 
tions, 



OF PHYSIC. ttit 

tions, I think fuch a difeafe mufl be con- 
sidered as different from the Mania de~» 
fcribed above; and alfo, though partial* 
mufl be held as different from the pro- 
per Melancholia to be mentioned here- 
after. 

1577. Such a difeafe, as different from 
thofe defcribed (1554) requires, in my opi- 
nion, a different admin iftration of reme- 
dies ; and it will be proper for me to take 
particular notice of this here. 



Although it may be neceffary to re-* 
ftrain fuch infane perfons as we have men- 
tioned (1576) from purfuing tht objecls 
of their falfe imagination or judgement, 
it will hardly be requifite to employ the 
fame force of reftraint that is neceffary 
in the impetuous and 'angry mania. It 
will be generally fufficienr to acquire fome 
awe over them, that may be employed, 

and 



i8i , P.RA.CTI C E 

and fometimes even be necefTary, to check 
the rambling of their imagination, and 
incoherency of judgement. 

1578. The reftraintjuft now mentioned 
as necefTary will generally require the 
patient's being confined to one place for 
the fake of excluding the objects, and 
more particularly the perfons, that might 
excite ideas connected with the chief 
objects of their delirium. Atr the fame 
time, however, if it- can be perceived there 
are objects or perfons that can call off 
their attention from the purfuit of their 
own difordered imagination, andean fix 
it a little 1 upon fome others, thefe lad 
may be frequently prefented to them : and 
for this reafon a journey, both by its hav- 
ing the effect of interrupting all train of 
thought, and by prefenting objects engag- 
ing attention, may often ' be ufeful. In 
fuch cafes alfo, when the infanity, though 

more 



OF PHYSIC 183 

more efpecially fixed upon one miftaken 
fubject, is not confined to this alone, but 
is further apt to ramble over other fub- 
jecls with incoherent ideas, I apprehend 
the confining or forcing fuch perfons to 
fjme conftant uniform labour, may prove 
an ufeful remedy. 

1579. When fuch cafes as in (1576) oc- 
cur in fanguine temperaments, and may 
therefore approach more nearly to Phre- 
nitic Delirium; fo, in proportion as the 
fymptoms of this tendency are more evi- 
dent and confiderable, blood-letting and 
purging -will be the more proper and ne- 
ceflary. 

1580. To this fpecies of infanity, when 
occurring in fanguine temperaments, whe- 
ther it be more or lefs partial, I apprehend 
that cold bathing is particularly adapted ; 
while, in the partial infanity of melan- 
cholic 



iS4 Practice 

Cholic perfons, as I fhall mow hereafter* 
it is hardly admifftble. 

158 1. Having thus treated of a fpecies 
of infariity, different, in my apprehenfion, 
from both the Mania and Melancholia, 
I proceed to confider what feems more 
properly to belong to this laft. 

1582. The difeafe which I name Melan- 
cholia is very often a partial infanity only. 
But as in many inftances, though the 
falfe imagination or judgement feems to 
be with refped to one fubjecl only ; yet it 
feldom happens that this does not produce 
much inconfiflency in the other intellec- 
tual operations : And as, between a very 
general and a very partial infanity, there 
are all the pofTible intermediate degrees ; 
fo it will be often difficult* or perhaps im- 
proper, to diftinguifh melancholia by th& 
character of Partial Infanity alone. If t 

miftake 



OF PHYSJC. . 185 

miftake not, it mud be chiefly diftin- 
guifhed by its occurring in perfons of 
a melancholic temperament, and by its 
being always attended with Tome feem- 
™gty groundlefs, but very anxious, 
fear. 

. 1583. To explain the caufe of this, I 
muft obferve, that perfons of a melancho- 
lic temperament are for the moft part of 
a ferious thoughtful difpofition, and dif- 
pofed to fear and caution, rather than 
to hope and temerity. Perfons of this 
caft are lefs moveable than others by 
any impreffions ; and are therefore capa- 
ble of aclofer or more continued attention 
to one particular object, or train of think- 
ing. They are even ready to be engaged 
in a conftant application to one fubjecT: ; 
and are remarkably tenacious of what- 
ever emotions they happen co be affe&ed 
with. , * 

Vol. IV. N 1584. Thefe 



i86 PRACTICE 

' 1584. Thefe circumftances of the me-, 
lancholic character, feem clearly to mow, 
that perfons ftrongly affected with it may 
be readily feized with an anxious fear; 
and that this, when much indulged, as is 
natural to mch perfons, may eafily grow 
into a partial infanity. 

1585. Fear and dejection of mind, or 
a timid and defponding difpofition, may 
arife in certain ftates, or upon certain oc? 
cafions of mere debility ; and it is upon 
this footing, that I fuppofe it fornetimes to 
attend dyfpepfia. But in thefe cafes, I 
believe the defpondent difpofition hardly 
ever arifes to a ; conliderable degree, or 
proves fo obftinately fixed as when it oc- 
curs in perfons o*f a melancholic tempera- 
ment. In thefe laft, although the fear 
proceeds from the fame dyfpeptic feelings 
as in the other cafe, yet it will be obvious, 
that the emotion may rife to a' more con- 
siderable 



OF PHYSIC. 187 

fiderable degree ; that it may be more 
anxious, more fixed, and more attentive ; 
and therefore may exhibit all the various 
circumftances which I have mentioned in 
1222, to take place in the difeafe named 
Hypochondriasis. 

1586. In confidering this fubject for- 
merly in diftinguifhing Dyfpepfia from 
Hypochondriacs, although the fymptoms 
affecting the body be very much the fame 
in both, and even thofe affecting the 
mind be fomewhat fimilar, I found no 
difficulty in diftinguifhing the latter dif- 
eafe,. merely from its occurring in per- 
fons of a melancholic temperament. But 
I muft now acknowledge, that I am at 
a ldfs to determine how in all cafes 
hypochondriacs and melancholia may be 
diftinguifhed from one another, whilft 
the fame temperament is common to 
both. 

- N 2 1587. I 



188 P R A C T LC E 

1 587. I apprehend, however, that the 
diftindlion may be generally afcertained 
in the following manner. 

The hypochondriacs I would conuder 
as being always attended with dyfpeptic 
fymptoms : and though there may be, at 
the fame time an anxious melancholic fear 
arifing from the feeling of thefe fymptoms: 
yet while this fear is only a mi (taken 
judgement with refpecl to the ft ate of the 
perfon's own health, and to the danger to 
be from thence apprehended, I would ftill 
conuder the difeafe as a hypochondriasis, 
and as diftinct from the proper melancho- 
lia. But when an anxious fear and de- 
fporidency arifes from a miftaken judge- 
ment with refpecl: to other circumftances 
than thofe of health, and more efpecially 
when the perfon is at the fame time 
without any dyfpeptic fymptoms, every 
one will readily allow this to be a difeafe 

widely 



OF PHYSIC, ' 189 

widely different from both dyfpepfia and 
hypochondriafis ; and it is, what I would 
ftrictly name Melancholia. 

1588. In this there feems little dif- 
ficulty : but as an exquifitely melancholic 
temperament may induce a torpor and 
flownefs in the action of the ftomach, fo 
it generally produces fome dyfpeptic 
fymptoms ; and from thence there may 
be fome difficulty in diftinguifhing fuch 
a cafe from hypochondriafis. But I would 
maintain, however, that when the cha- 
racters of the temperament' are ftrongly 
marked ; and more particularly When the 
falfe imagination turns upon other fub* 
jects than that of health, or when, though, 
relative to the perfon's own body, it is of 
a groundlefs and abfurd kind ; then, not- 
withstanding ,the appearance of fome 
dyfpeptic- fymptoms, the cafe is ftill to be 
N 3," confidered 



igo PRACTICE 

confidered as that of a melancholia, rather 
than a hypochondriacs. 

1589. The difeafe of .melancholia,' there- 
fore, manifestly depends upon the general 
temperament of the body : and although, 
in many perfons, this temperament is not 
attended with any morbid affection either 
of mind or body ; yet when it becomes 
exquiutely formed, and is in a high de-» 
gree,' it may become a difeafe affecting 
both, and particularly the mind. It will 
therefore be proper to conflder in what 
this melancholic temperament efpecially 
confifts ; and to this purpofe, it may be 
obferved, that in it there is a degree of 
torpor in the motion of the nervous 
power, both with refpect to fenfation and 
volition; that there is a. general rigidity 
of the fimple folids ; and that the balance 
of the ianguiferous fyftem, is upon the 
fide of the veins. But all thefe circum- 
% , ftances 



O F P H Y S I C. 191 

fiances are the directly oppofite of thofe 
of the fariguine temperament ; and muft 
therefore alfo produce an oppofite flate of 
mind. 

1590. It is this flate of mind, and the 
flate of the brain correfponding to it, 
that is the chief object of ouf prefent con- 
sideration. But what that Mate of the 
brain is, will be fuppofed to be difficult 
to explain ; and it may perhaps feem rafh 
in me to attempt it. 

1 will, however venture to fay, that it 
is probable the melancholic temperament 
of mind depends upon a' drier and firmer 
texture in the medullary fubflance of the 
brain ; and that this perhaps proceeds 
from a certain want of fluid in that fub- 
ftance, which appears from its being of a 
lefTer fpecific gravity than ufual. That 
this flate of the brain in melancholia does 
N 4 actually 



192 PRACTICE 

actually exift, I conclude, firfi^ from the 
general frigidity of the whole habit ; and,. 
Jecondly y from directions, mowing fuch 
a ftate of the brain to have taken place 
in mania, which is often no other than a 
higher degree of melancholia. It does not 
appear to me anywife difficult to fuppofe, 
that the fame ftate of the brain may in a 
moderate degree give melancholia ; and 
in a higher, that mania which " melan- 
cholia fo often paffes into j especially, if I 
mall be allowed further to fuppofe, that 
either a greater degree of firmnefs in the 
fubftance of the brain may render it fu£ 
ceptible of a higher degree of excitement, 
or that one portion of the brain may be 
liable to acquire a greater firmnefs than 
others, and confequently give occafion to 
that inequality of excitement upon which 
mania fo much depends. 

159 1. I have thus endeavoured to deli- 
3 ver * 



OF PHYSIC. 193 

ver, what appears to me moft probable 
with refpect to the proximate caufe of 
melancholia; and although the matter 
fhould in fome refpects remain doubtful, 
I am well perfuaded that thefe obferva-^ 
tions may often be employed to direct our 
practice in this difeafe, as I fhall now en- 
deavour to fhow. 

1592. In moft of the instances of me- 
lancholia, the mind is to be managed ve- 
ry much in the fame manner as I have 
advifed above with regard to hypochon- 
driacs ; but as in the cafe of proper me- 
lancholia, there is commonly a falfe ima- 
gination or judgement appearing as a par- 
tial infanity, it may be further necefTary 
in fuch cafes to employ fome artifices for 
correcting fuch imagination or judge- 
ment. 

J 593- The various remedies for reliev- 
ing 



, i94 PRACTICE 

ing the dyfpeptic fymptoms which al- 
ways attend hypochondriafis, will feldom 
be either requifite or proper in melan- 
cholia. 

There is only one of the dyfpeptic 
fymptoms, which, though there mould 
be no other, is very conftantly prefent in 
melancholia, and that is coltivenefs. This 
it is always proper and even neceffary to 
remove; and I believe it is upon this ac- 
count that the ufe of purgatives has been 
found fo often ufeful in melancholia. 
Whether there be any purgatives pecu- 
liarly proper in this cafe, 1 dare not posi- 
tively determine ; but with refpecr to the 
choice of purgatives in melancholia, I am 
of the fame opinion that I delivered above, 
on this fame fubjedt, with refpedl to ma- 
nia. 

1594. With refpecl to 6ther remedies, 

I 



OF PHYSIC. 195 

I judge that blood- letting will more fel- 
dom be proper in melancholia, than in 
mania ; but how far it may be in any 
cafe proper, muft be determined by the 
fame confiderations as in the cafe of ma- 
nia. 

1595. The cold bathing that I judged 
to be fo very ufeful in feveral cafes of 
infanity, is, I believe, in melancholia, 
hardly ever fit to be admitted; at leaft 
while this is purely a partial affedlion, 
and without any marks of violent excite- 
ment. On the contrary, upon account 
of the general rigidity prevailing in me- 
lancholia, it is probable that warm bath- 
ing may be often ufeful. 

1596. With refpec~t to opiates, which I 
have fuppofed might often be ufeful in 
cafes of mania, I believe they can fel- 
dom be properly employee! in the partial 

infanities 



196 PRACTICE 

infanities of the melancholic, except ill 
certain inftances of violent * excitement, 
when the melancholia approaches nearly 
to the ftate of mania. 

1597. In fuch cafes of melancholia ap- 
proaching to a ftate of mania, a low diet 
may fome times be neceflary; but as the 
employing a low diet almoft unavoid- 
ably leads to the ufe of vegetable food, 
and as this in every torpid ftate of the 
ftomach is ready to. produce fome dyf- 
peptic fymptoms, fuch vegetable food 
ought, in moderate cafes of melancholia, 
to be ufed with ibme caution. 

Though exercife, as a tonic power, is 
not proper either in hypochondriafis or' 
melancholia; yet, with refpedl to its ef- 
fe&s upon die mind, it may be extremely 
ufeful in both, and in' melancholia is to 
be employed in the fame manner that 

X 



OF PHYSIC. 197 

I have advifed above in the cafe of hypo- 
chondriacs. 

1598. Having now delivered my doc- 
trine with refpect to the chief forms of 
infanity, I mould in the next place pro- 
ceed to confider the other genera of A- 
mentia and Oneirodynia, which in the 
Nofology I have arranged under the or- 
der of Vefaniae: but as I cannot pretend 
to throw much light upon thefe fubjecls, 
and as they are feldom the objects of prac- 
tice, I think it allowable for me to pafs 
them over at prefent ; and the particular 
circumftances of this work in fome mea- 
fure requires that I fhould do fo. 



PART 



PART III. 



OF 



CACHEXIES. 



1 599* T JNDER this title I propofe to 

^ eftablifh a clafs of difeafes, 

which confift in a depraved ftate of the 

whole, or of a confiderable part, of the 

habit 



200 PRACTICE 

habit of the body, without any primary 
pyrexia or neurofis combined with that 
ftate. 

1600. The term Cachexy has been em- 
ployed by Linnaeus and Vogel, as it had 
been formerly by other authors, fpr the 
name of a particular difeafe ; but the dif- 
eafe to which thefe authors have affixed 
it, comes more properly under another 
appellation ; and the term of Cachexy is 
more properly employed by Sauvages 
and Sagar for the name of a clafs. In 
this, I have followed the laft- mentioned 
nofologifts, though I find it difficult to 
give fuch a character of the clafs as will 
clearly apply to all the fpecies I have 
comprehended under it. This difficulty 
would be dill greater, if, in the clafs I 
have eflablifhed under the title of Cachex- 
ies, I were to comprehend all the difeafes 
that thofe other nofologifts have done ; 

but 



O F P H Y S I C. so* 

but I am willing to be thought deficient 
rather than very incorreft. Thofe difficul- 
ties, however, which ftill remain in me- 
thodical nofology, muft not affect us 
much in a treatife of practice. If I can 
here properly diftinguifh and defcribe the 
feveral fpecies that truly and raoft com- 
monly exift, I fhall be the lefs concerned 
about the accuracy of any general clafft- 
fication : though at the fame time this, I 
think, is always to be attempted; and 
I fhall purfue it as well as I can. 



Voi. IV. O BOOK 



BOOK I. 



QF 



EMACIATIONS. 



1 60 1. TpMACIATION, or a confidera- 

-*- J ble diminution of the bulk 

or plumpnefs of the whole body, is for 

the moil part only a fymptom of difeafe, 

O 2 and 



20 4 PRACTICE 

and very feldom to be confidered as a pri- 
mary and idiopathic affection. Upon this 
account, according to my general plan, 
fuch a fymptom might perhaps have been 
omitted in the Methodical Nofology : but 
both the uncertainty of concluding it tq 
be always fymptomatic, and the confif- 
tency of fyftern, made me introduce into 
the Nofology, as others had done, an order 
under the title of Mar cores ; and this ren- 
ders it requifite now to take fome notice, 
- of fuch difeafes. 

1602. Upon this occafion, therefore, I 
hope it may be ufeful to inveftigate the fe- 
yeral caufes of emaciation in all the dif- 
ferent cafes of difeafes in which it appears. 
And this 1 attempt, as the fureft means of 
determining how far it is a primary, or a 
fymptomatic affection only ; and even in 
the latter view, the inveftigation may be 
attended with fome advantage. 

- 1605. The 



OF PHYSIO. 205 

1603. The caufes of emaciation may, I 
apprehend, be referred to two general 
heads ; that is, either to a general deficien- 
cy of fluids in the vefTels of the body, or to 
the particular deficiency of the oil in the 
cellular texture of it *. Thefe caufes are 
frequently combined together ; but it will 
be proper, in the firft place, to confider 
them feparately. 

1 604. As a great part of the body of a- 
flimals is made up of vefTels filled with 
fluids, the bulk of the whole muft depend 
very much on the fize of thefe vefTels, and 
the quantity of fluids prefent in them : and 
it will therefore be fufKciently obvious, that 
a deficiency of the fluids in thefe vefTels 
muft, according to its degree^ oceafion a 
proportionate diminution of the bulk of 

O 3 , the 

* Might not a third caufe be added, viz. a deficiency 
•f the folid parts ? 



$*$ PRACTICE 

the whole body. This, however, will ap. 
pear ftiU more clearly from confidering 
that, in the living and found body, the ve£ 
fels every where feem to* be preternaturally 
diftended by the quantity of fluids prefent 
in them ; but being at the fame time ela£ 
tic, and conftantly endeavouring to con- 
tract themfelves, they mud on the with- 
drawing of the diftending force, or, in 6- 
ther words, upon a diminution of the 
quantity of fluids, .be in proportion con- 
tracted and diminished in their fize : And 
it may be further obferved, that as each, 
part of the vafcular fyftem communicates 
with every other part of it ; fo every de- 
gree of diminution of the quantity of 
fluid, in any one part, mufl in proportion^ 
diminifh the bulk of the vafcular fyftem, 
and confeq.uently of the whole body *. 

1605, The 

* There- may however be a partial without a general, 

emaciation^. 



OF PHYSIC, 207 

1605. The diminution and deficiency 
of the fluids may be occafioned by diffe- 
rent caufes : fuch as, firft by a due quan- 
tity of aliments not being taken in ; or by 
the aliment taken in not being of a fuffi- 
ciently nutritious quality. Of the want 
of a due quantity of aliment not being ta- 
ken into the body, there is "an inftance in 
the Atrophia laSlantium Sauvagefii, fpecies 
3. and many other examples have occur- 
red of emaciation from want of food, oc- 
cafioned by poverty, and other accidental 
eanfes* 

With refpecl to the quality of food, I 

apprehend, it arifes from the want of 

O 4 nutritious 

emaciation, as is the cafe in a palfiev.1 limb ; but this par- 
tial diminution of bulk in the difeafed limb is not owing 
to a leffened quantity of the general mafs of the circula- 
ting fluids, but to the languid circulation in that part, the 
arteries not propelling the blood through it with fuffi* 
cient vigour. 



ao8 PRACTICE 

nutritious matter in the food employed, 
that perfons living very entirely on vege- 
tables are feldom of a plump and fuccu- 
lent habit*, 

1 606. A fecond caufe of the deficiency 
of fluids may be, the aliments taken in 
not being conveyed to t;he blood-veffels. 
This may occur from a perfon's being af- 

feded 



* As the author fays at the conclufion of this chap- 
ter, " After having confidered the various caufes of e* 
• " maciations, I fhould perhaps treat of their cure: but 
** it will readily appear, that the greater part of the 
" cafes above-mentioned are purely fymptomatic, and 
" confequently that the cure of them muft be that of the 
" primary difeafes upon which they depend. Of thofe 
" cures that can any wife, be confidered as idiopathic, it 
"'; will appear that they are to be cured entirely by re- 
"' moving the remote caufes ;" It may not be improper 
to treat ef the cure as we proceed. 

This fpecies of emaciation maybe obfioufly cured by 
a rich and nutritious diet. 



OF PHYSIC. 209 

fecled with a frequent vomiting; which, 
rejecting the food foon after it had been 
taken in, muft prevent the necefTary fup- 
ply of fluids to the blood- veffels*. 

Another caufe, frequently interrupting 
the conveyance of the alimentary matter 
into the blood- vefTels, is an obftru&ion of 
the conglobate or, lymphatic glands of the 
mefentery, through which the chyle, muft 
neceffarily pafs to the thoracic duel. 
Many inftances of emaciation, feemingly 
depending upon this caufe, have been ob- 
ferved by phyficians, in perfons of all 
ages, but efpecially in the young. It has 
alfo been remarked, that fuch cafes have 
moft frequently occurred in fcrophulous 
perfons, in whom the mefenteric glands 

are 

* This fpecies may be cured by preventing the vo- 
Uniting by antifpafmodics, efpecially opium, and by the 
ufe of gentle laxatives occafionally. A nutritious diet 
will alfo be neceffary in thefe cafes. 



2io PRACT CE 

are commonly affected with tumour of 
ob-ftruction, and in whom, generally at 
the fame time, fcrophula appears external- 
ly. Hence the Tabes fcrophulofa Synop, 
Nofolog. vol. ii. p. 266. And under thefe 
I have put as fynonimes Tabes glandularis ■, 
fp. 10.; Tabes mefent erica, fp. 9. j fcrophula 
mefent erica, fp. 4*; Atrophia infantilis, fp. 
13.; Atrophia rachitica, fp. 8.; Tabes ra- 
chialgica, fp. 16. At the fame time, I 
have frequently found the cafe occurring 
in perlbns who did not fhow any external 
appearance of fcrophula, but in whom 
the mefenteric obstruction was afterwards 
difcovered by diffe&ion. Such alfo I fup- 
pofe to have been the cafe in the difeafe 
frequently mentioned by authors under 
the title of the Atrophia infantum. This 
has received its name from the time of 
life at which it generally appears ; but I 
have met with inftances of it at fourteen 
' years of age afcertained by diffeclion. In 
1 feveral 



OF PHYSIC. 2it 

feveral fuch eafes which I have feen, the 
patients were without" any fcrophulous ap- 
pearances at the time, or at any period of 
their lives before *. 

In the cafe of phthifical perfbns, I {hall 
hereafter mention another caufe of their 
emaciation ; but it is probable that an ob- 
ftruclion of the mefenteric glands, which 
fo frequently happens in fuch . perfbns,, 

concurs 



* Thefe cafes are generally incurable ; if, however 
there be no furpicion of fcrophula, we may attempt a 
cure by endeavouring to remove the ©bftruct-ion either 
by invigorating the habit, or by active aperients- 
Open and pure air, with exercife fuited to the ftrength' 
of the patient, and the ufe of chalybeate waters,, have 
admirable effe&s in thefe cafes. ' 

Peruvian bark fo often ufed as a tonic, is improper 
in all cafes of obftrufted glands, as are alfo aftringente> 
ami ftyptios. 



2(2 PRACTICE 

concurs very powerfully in producing thd 
emaciation that takes place. 

Although a fcrophulous taint may be 
the moft frequent caufe of mefenteric ob- 
structions, it is fufficiently probable that 
other kinds of acrimony may produce 
the fame, and the emaciation that fol- 
lows* 

It may perhaps be fuppofed, that the 
interruption of the chyle's pafTing into 
the blood-velTels may be fometimes ow- 
ing to a fault of the abforbents on the 
internal furface of the interlines. This, 
however, cannot be readily afcertained : 
but the interruption of the chyle's pafling 
into the blood-veffels may certainly be 
owing to a rupture of the fhoracic duel ; 
which, when it does not prove foon fatal, 
by occasioning an hydrothorax, muft in 

a 



OF PHYSIC. 213 

a fhort time produce a general emacia- 
tion *. 

1607. A third caufe of the deficiency 
of fluids may be a fault in the organs of 
digeftion, as not duly converting the ali- 
ment into a chyle fit to form in the 
blood-velTels a proper nutritious matter. 
It is not, however, eafy to afcertain the 
cafes of emaciation which are to be at- 
tributed to this caufe; but I apprehend 
that the emaciation which attends long 
fubfifting cafes of dyfpepfxa, or of hypo- 
chondriafis, is to be explained chiefly in 
this way. It is this which 1 have placed 
in the Nofology under the title of the 
Atrophia debilium; and of which the Atro- 
phia nervofa, Sauv. fp. 1. is a proper in- 
flance, and therefore put there as a fyno- 
nime. But the other titles of Atrophia la- 
teralis, 

♦.This is an abfolutely incurable cafe. 



214 PRACTICE 

teralis, Sauv. fp. 15. and Atrophia fenilis^ 
Sauv. fp. 11. are not fo properly put 
there, as they mud be explained in a 
different manner*. 

1608. A fourth caufe of a deficiency of 
the fluids in the body, may be exceflivc 
evacuations made from it by different out- 
lets ; . and Sauvages has properly enume- 
rated the following fpecies, which we 
have put as fynonimes under the title of 
Atrophia inanitonim; as, Tabes nutricum, 
fp. 4. Atrophia nut neurit) fp. 5. Atrophia 
a leucorrh&a, fp. 4. Atrophia ah alvijluxu, 
fp. 6. Atrophia a ptyalifmo^ fp. 7. and 
laftly, the Tabes afanguifiuxu; which, it is 
to be obferved, may arife not only from 

fpontaneous 



* This fpecies of emaciation may be fuccefsfully 
cured by the means of thofe remedies mentioned in the 
notes on the articles 1204, 1206, 1210, 1212, 1213, 

1215, I2l6, '2221. 



O F P H Y S I C. 215 

fpontaneous hemorrhagies or accidental 
wounds, but alfo from blood-letting in 
too large a quantity, and too frequently- 
repeated. 

Upon this fubject it feems proper to 
obferve, that a meagre habit of body fre- 
quently depends upon a full perfpiration 
being constantly kept up, though at the 
fame time a large quantity of nutritious 
aliment is regularly taken in *. 

1609. Befides this deficiency of fluids 
from evacuations by which they are car- 
ried entirely out of the body, there may 
be a deficiency of fluid and emaciation 
in a confiderable part of the body, by 

the 



* In thefe cafes aftringents are the principal remedies 
on which we muft depend ; and thofe aftringents muft 
be chofen which are adapted to fupprefs the peculiar e- 
vacuation that occafions the difeafe. 



3i6 PRACTICE 

the fluids being drawn into one part, or' 
collected into one cavity ; and of this we 
have an inftance in the Tabes a hydrops, 
Sauv* fp. 5 *. 

1610. In the Methodical Nofolbgy, a- 
mong the other fynonitnes of the Atrophia 
inanitorum, I have fet down the Tabes dor<r 
falls ; but whether properly or not, I at 
prefent very much doubt. In the evacua- 
tion confidered as the caufe of this tabes, 
as the quantity evacuated is never fo great 
as to account for a general deficiency of 
fluids in the body, we muft feek for ano- 
ther explanation of it. And whether the' 
effects of the evacuation may be accounted 
for, either from the quality of the fluid 
evacuated, or from the Angularly enervat- 
ing 

* The emaciation from this caufe is merely fymptQ- 
rnatic, and can only be cured by curing the primary 
difeafe. 



O F P H Y S I C. . 217 

ing pleafure attending the evacuation, or 
from the evacuation's taking off the tenfion 
of parts, the tenfion of which has a lingu- 
lar power in fupporting the tenfion and 
vigour of the whole body, I cannot po- 
fitively determine ; but I apprehend that 
upon one or other of thefe fuppofitions 
the emaciation attending the tabes dorfalis 
mud be accounted for ; and therefore, 
that it is to be confidered as an inftance 
of the Atrophia debilium^ rather than of the 
Atrophia inanitorum*. 

161 1. A fifth caufe of a deficiency of 
fluids and of emaciations in the whole or 
in a particular part of the body, may be 
the concretion of the fmall vefTels, either 
not admitting of fluids* or of the fame 
proportion as before : and this feems to 

Vol. IV. P me 

* If a particular abominable practice be the caufe, il 
muft be abandoned before a cure can be attempted. 



218 PRACTICE 

me to be the cafe in the Atrophia fenilis, 
Sauv. fp 2. Or it may be a palfy of the 
larger trunks of the arteries rendering 
them unfit to propel the blood into the 
fmaller vefTels ; as is frequently the • cafe 
of paralytic limbs, in which the arteries 
are affected as well as the mufcles. The 
Atrophia lateralis, Sauv. fp. 15. feems to 
be of this nature *. 

16 1 2. A fecond general head of the 
caufes of emaciation I have mentioned in 
1602. to be a deficiency of oil. The ex- 
tent and quantity of the cellular texture 
in every part of the body, and therefore 
how . considerable a part it makes in the 
bulk of the whole, is now well known. 
But this fubftance, . in different circum- 

ftances, 

* This is one of the incurable fpecies of emaciation, 
and it can only be relieved by a very nutritious and in- 
vigorating diet. 



OF PHYSIC. 219 

fiances, is more or lefs filled with an oily 
matter ; and therefore the bulk of it, and 
in a great meafure that of the whole body, 
mult be greater or lefs according as this 
fubftance is more or lefs filled in that 
manner. The deficiency of fluids, for a 
reafon to be immediately explained, is 
generally accompanied with a deficiency 
of oil: but phyficians have commonly at- 
tended more to the latter caufe of emacia- 
tion than to the other, that being ufually 
the moft evident ; and I fhall now endea- 
vour to affign the feveral caufes of the de- 
ficiency of oil as it occurs upon different 
occafions. 

1 6 13. The bufinefs of fecretion in the 
human body is in general little under- 
ftood, and in no inftance lefs fo than that 
of the fecretion of oil from blood which 
does not appear previoufly to have con- 
tained it. It is poffible, therefore, that 
P 2 our 



22o PRACTICE 

our theory of the deficiency of oil may be 
in feveral refpects imperfect ; but there 
are certain facts that may in the mean 
time apply to the prefent purpofe. 

1 614. Firft, it is probable, that a defici- 
ency of oil may be owing to a ftate of the 
blood in animal bodies lefs fitted to afford 
a fecretion of oil, and confequently to fup- 
ply the wafte of it that is conftantly made. 
This ftate of the blood muft efpecially de- 
pend upon the ftate of the aliments taken 
in, as containing lefs of oil or oily matter. 
From many obfervations made, both with 
refpect to the human body and to that of 
other animals, it appears pretty clearly, 
that the aliments taken in by men and 
domeftic animals, according as they con- 
tain more of oil, are in general, more 
nutritious, and in particular are better 
fitted to fill the cellular texture of their 
2 . bodies 



OF PHYSIC. 221 

bodies with oil. I might illuftrate this, 
by a minute and particular confideration 
of the difference of alimentary matters 
employed ; but it will be enough to give 
two inftances. The one is, that the her- 
baceous part of vegetables, does not fatten 
animals, i'o much as the feeds of vege- 
tables, which manifeftly contain in any 
given weight a greater proportion of oil ; 
and a fecond inftance is, that in general 
vegetable aliments do not fatten men fo 
much as animal food, which generally 
contains a larger proportion of oil. 

It will be obvious, that upon the fame 
principles* a want of food, or a lefs nu- 
tritious food, may not only occafion a 
general deficiency of fluids (1604), but 
muft alfo afford lefs oil, to be poured 
into the cellular texture. In fuch ca- 
fes, therefore, the emaciation produced, 
P 3 is, 



222 PRACTICE 

is to be attributed to both thefe genera^ 
caufes *. 

1 6 15. A fecond cau-fe of the deficiency 
of oil may be explained in this manner. 
It is pretty manifeft, that the oil of the 
blood is fecreted and depofited in the cel- 
lular texture in greater or leffer quantity, 
according as the circulation of the blood 
is fafter or flower ; and therefore that 
exercife, which haftens the circulation of 
the blood, is a frequent caufe of emacia- 
tion. Exercife produces this efFecl in two 
ways. 1 ft, By increafmg the perfpiration^ 
and thereby carrying off a greater quan- 
tity of the nutritious matter, it leaves lefs 
of it to be depofited in the cellular tex- 
ture ; thereby not only preventing an ac- 
cumulation of fluids, but, as I have faid 
3 above, 

*- The cure of this fpeci.es of emaciation will be beft 
cffecled by a rich diet of animal food. 



O F P H Y S I C. 223 

above, caufing a general deficiency of 
thefe, which muft alfo caufe a deficiency 
of oil in the cellular texture. 2dly, It is 
well known, that the oil depofited in the 
cellular' texture is upon many occafions, 
and for various purpofes of the ceconomy, 
again abforbed, and mixed or dirfufed in 
the mafs of blood, to be from thence per- 
haps carried entirely out of the body by 
the feveral excretions. Now, among other 
purpofes of the accumulation and re-ab- 
forption of oil, this leems to be one, that 
the oil is requifite to the proper action of 
the moving fibres in every part of the 
body ; and therefore that nature has pro- 
vided for an abforption ot oil to be mad^ 
according as the action of the moving' 
fibres may demand it. It will thus be ob- 
vious, that the exercife of the mufcuiar 
and moving fibres every where, muft oc- 
casion an abforption of oil ; and confe- 
quently that fuch exercife not only pic- 
P 4 vents 



224 PRACTICE 

vents the fecretion of oil, as has been al- 
ready faid, but may alfo caufe a deficien- 
cy of it, by occafioning an abforption of 
■what had been depofited ; and in this way, 
perhaps efpecially does it produce ema- 
ciation *. 

1616. A third cafe of the deficiency of 
oil may occur from the following caufe. 
It is probable, that one purpofe of the ac- 
cumulation of oil in the cellular texture 
of animals is, that it may, upon occafion, 
be again abforbed from thence, and car- 
ried into the mafs of blood, for the pur- 
pofe of enveloping and correcting any 
unufual acrimony arifing and exifting in 
the ftate of the fluids. Thus, in moft 
inftances in which we can difcern an 
acrid ftate of the fluids, as in fcurvy, 

cancer, 

* Abftinence from too fevere exercife is the only 
cure for this fpecie's of the difeafe. 



O F P H Y S I C 225 

cancer, fyphilis, poifons, and feveral other 
difeafes, we find at the fame time a de- 
ficiency of oil and an emaciation take 
place ; which, in my apprehenfion, mull 
be attributed to the abforption of oil, 
which the prefence of acrimony in the 
body excites. 

It is not unlikely that certain poifons 
introduced into the body, may fubfifl: 
there ; and, giving occafion to an abforp- 
tion of oil, may lay a foundation for tlje 
Tabes a veneno, Sauv. fp. 17*. 

161 7. A 



* As this kind of emaciation proceeds from various 
caufes, the practitioner, muft, after having afcertained 
the true caufe, endeavour to remove it ; and this muft 
be left entirely to his own fagacity. It may however 
be proper to obferve, that feveral of thefe emaciations 
proceed from incurable difeafes ; as from Cancer, Scro- 
phula, &c and confequently admit of no cure : And 
thofe emaciations which proceed from fcurvy, fyphilis, 



226 PRACTICE 

1617. A fourth cafe of emaciation, 
and which I would attribute to a fudden 
and confiderable abforption of oil from 
the cellular texture, is that of fever, 
which fo generally produces emaciation. 
This may perhaps be in part attributed 
to the increafed perfpiration, and there- 
fore to the general deficiency of fluids 
that may be fuppofed to take place : but 
whatever fliare that may have in produ- 
cing the effect, we can, from the evident 
fhrinking and diminution of the cellular 
fubftance, wherever it falls under our 
obfervation, certainly conclude, that there 
has been a very confiderable abforption 
of the oil which had been before depo- 
fited in that fubftance. This explanation 
is rendered the more probable from this, 
that I fuppofe the abforption mentioned 

is 



or thofe difeafes which' we can cure, are only to be cur-* 
ed by curing the primary difeafe. 



OF PHYSIC. 227 

is neceffarily made for the purpofe of 
enveloping or correcting an acrimony, 
which manifeftly does in many, and may 
be fufpected to arife in all, cafes of fever. 
The moft remarkable inftance of emacia- 
tion occurring in fevers, is that which 
appears in the cafe of hectic fevers. Here 
the emaciation may be attributed to the 
profufe fweatings that commonly attend 
the difeafe : but there is much reafon to 
believe, that an acrimony alfo is prefent 
in the blood, which, even in the begin- 
ning of the difeafe, prevents the fecretion 
and accumulation of oil ; and in the 
more advanced ftates of it, muft occafion 
a more confiderable abforption of it ; 
which, from the fhrinking of the cellular 
fubftance, feems to go farther than in a,l- 

moft any other inftance *, 

Upon 

* This emaciation is purely fymptomatie, and confe- 
cmently cannot be cured but by removing the pri- 
mary 



228 PRACTICE 

Upon the fubject of emaciations from 
a deficiency of fluids, it may be obferved, 
that every increafed evacuation excites an 
abforption from other parts, and particu- 
larly from the cellular texture ; and it is 
therefore probable, that a deficiency of 
fluids, from increafed evacuations, pro- 
duces an emaciation, not only by the 
wafte of the fluids in the vafcular fyftem, 
but alfo by occafioning a considerable 
abforption from the cellular texture, 

1618. I have thus endeavoured to ex- 
plain the feveral cafes and caufes of ema- 
ciation ; but I could not profecute the 
confideration of thefe here in the order 
they are fet down in the Methodical No- 
1 fology. In that work I was engaged 
chiefly in arranging the fpecies of Sau- 

vages ; 

mary difeafe, and a fubfequent very nutritious diet, con- 
Ming chiefly of animal food. 



of physic: 229 

vages ; but it is my opinion now, that the 
arrangement there given is erroneous, in 
both combining and feparating fpecies im- 
properly : and it feems to me more pro- 
per here to take notice of difeafes, and 
put them together, according to the affi- 
nity of their nature, rather than by that 
of their external appearances. I doubt, if 
even the diftin&ion of the Tabes and A- 
trophia, attempted in the Nofology, will 
properly apply ; as I think there are cer- 
tain difeafes of the fame nature, which 
fometimes appear with, and fometimes 
without fever. 

1 619. After having confidered the vari- 
ous cafes of emaciations, I mould per- 
haps treat of their cure : but it will rea- 
dily appear that the greater part of the 
cafes above mentioned are purely fym- 
ptomatic, and confequently that the cure 
of them muft be that of the primary 

difeafes 



£3© PRACTICE 

difeafes upon which they depend. Of 
thofe cafes that can anywife be confidered 
as idiopathic, it will appear that they 
are to be cured entirely by removing the 
remote caufes ; the means of accomplifh- 
ing which rnuft be fufficiently obvious. 



BOOK ' 



BOOK II. 



OF 



INTUMESCENTIjE, 



OR 



GENERAL SWELLINGS. 



f 620. nr^HE fwellings to be floated of 

in this place are thofe which 

extend over th<? whole or a great part of 

the body ; or fuch at leaft, as, though of 

fmall 



ftp PRACTICE 

fmall extent, are however of the fame 
nature with thofe that are more generally- 
extended. 

The fwellings comprehended under this 
artificial order, are hardly to be diftin- 
guifhed from one another otherwife than 
by the matter they Contain or confift of: 
and in this view I have divided the order 
into four feclions, as the fwelling. happens 
to contain, i/?, Oil ; 2d, Air ; 3^, A wa- 
tery fluid ; or, q.th, As the increafed bulk 
depends upon the enlargement of the 
whole fubftance of certain parts, and 
particularly of one or more of the abdo- 
minal vifcera. 



CHAP. 



O F P H Y S I C. 233 



CHAP. I. 



F 



ADIPOSE SWELLINGS. 



162 1. HPHE only difeafe to be men- 

*■ tioned in this chapter, I 

have, with other Nofologifls, named 

Tofyfarcia; and in Englifh it may 

Vol. IV. Q^ be 



234 PRACTICE 

be named Corpulency, or, more ftriclly 
Obefity ; as it is placed here upon the 
common fuppofition of its depending 
chiefly upon the increafe of oil in the 
cellular texture of the body. This corpu- 
lency or obefity, is in very different 
degrees in different perfons, and is often 
eonfiderable without being confidered as 
a difeafe. There is, however, a certain 
degree of it, which will be generally al- 
lowed to be a difeafe; as, for example, 
when it renders perfons, from a difficult 
refpiration, uneafy in themfelves, and, 
from the inability of exercife, unfit for 
difcharging the duties of life to others : 
and for that' reafon I have given fuch 
a difeafe a place here. Many phyficians 
have confidered it as an object of prac- 
tice, and as giving, even in a very high 
degree, a difpofition to many difeafes ; 
I am of opinion that it fhould be an 
object of practice more frequently than it 

has 



OF PHYSIC. 235 

has been, and therefore that it merits 
our confederation here. 

1622. It may perhaps be alleged, 
that I have not been fufficiently correct, 
in putting the dileafe of corpulency as 
an intumefcentia pinguidinofa, and there- 
fore implying its being an increafe of the 
bulk of the body from an accumulation 
of oil in the cellular texture only. I am 
aware of this objection : and as I have al- 
ready faid, that emaciation 1602) de- 
pends either upon a general deficiency of 
fluids in the vafcular fyftem, or upon a 
deficiency of oil in the cellular texture ; fo 
I mould perhaps have obferved farther, 
that the corpulency, or general fulnefs of 
the body, may depend upon the fulnefs 
of the vafcular fyftem as well as upon 
that of the cellular texture. This is true 5 
and from the fame reafons I ought, per- 
haps, after Linnaeus and Sagar, to have 
Q^ 2 fet 



236 P R A C T I C E 

fet down plethora as a particular difeafe, 
and as an inftance of morbid intume- 
fcence. I have however avoided this, 
as Sauvages and Vogel have done, be- 
caufe I apprehend that plethora is to be 
confidered as a ftate of temperament only, 
which may indeed difpofe to difeafe; 
but not as a difeafe in itfelf, unlefs, in the 
language of the Stahlians, it be a plethora 
commota, when it produces a difeafe ac- 
companied with particular fymptoms, 
which give occafion to its being diftin- 
guifhed by a different appellation. Far- 
ther, it appears to me, that the fym- 
ptoms which Linnaeus, and more particu- 
larly thofe which Sagar employs in the 
character of plethora, never do occur but 
when the intumefcentia pinguidinofa has 
a great fhare in producing them. It is, 
however, very neceflary to obferve here, 
that plethora and obefity are generally 
combined together j and that ia fome 

cafes 



OF PHYSIC. 237 

cafes of corpulency it may be difficult 
to determine which of the caufes has the 
greateft fhare in producing it. It is in- 
deed very poffible that a plethora may 
occur without great obefity ; but I appre- 
hend that obefity never happens to a con- 
fiderable degree without producing a pie-, 
thora ad fpatium in a great part of the 
fyftem of the aorta, and therefore a pletho- 
ra ad molem in the lungs, and in the 
veflels of the brain. 

1623. In attempting the cure of poly- 
iarcia, I am of opinion that the conjunc- 
tion of plethora and obefity, in the man- 
ner juft now mentioned, fhould be con- 
ftantly attended to j and when the mor- 
bid effects of the plethoric habit are 
threatened, either in the head or lungs, 
that blood-letting is to be practifed : but 
at the fame time it is to be obferved, that 
perfons of much obefity do not bear 
Q^3 blood-letting 



23S PRACTICE 

blood-letting well ; and when the cir- 
cumftances I have mentioned do not im- 
mediately require it, the practice upon 
account of obefity alone, is hardly ever 
to be employed. The fame remark is to 
be made with refpect to any other evacu- 
ations that may be propofed for the cure 
of corpulency : for without the other 
means I am to mention, they can give 
but a very imperfeft relief; and, in fo 
far as they can either empty or weaken 
the fyftem, they may favour the return 
of plethora, and the increafe of obefi- 
ty. 

1624. Polyfarcia, or corpulency, whe- 
ther it depend upon plethora or obefity, 
whenever it either can be confidered as 
a difeafe, or threatens to induce one, is 
to be cured, or the effects of it are to be 
obviated, by diet and exercife. The 
diet mud be fparing j or rather, what is 

more 



OF PHYSIC. 239 

more admiffible, it muft be fuch as af- 
fords little nutritious matter. It mufl 
therefore be chiefly, or almoft only, of 
vegetable matter, and at the very utmoft 
of milk. Such a diet mould be employ- 
ed, and generally ought to precede ex- 
ercife; for obefity does not ealily admit 
of bodily exercife, which is, however, 
the only mode that can be very effectual. 
Such, indeed, in many cafes, may feem 
difficult to be admitted j but I am of 
opinion, that even the moft' corpulent 
may be brought to bear it, by at firfl 
attempting it very moderately, and in- ' 
creafing it by degrees very flowly, but at 
the fame time perfifting in fuch attempts 
with great conftancy *. 

1 625. As thefe, though the only effec- 
Q^4 tual 

* Befides the means mentioned by the author, eva- 
cuations of different kinds ought to be occasionally 
made, efpecially by purging and fweating. 



240 PRACTICE 

tual meafures, are often difficult to be 
admitted or carried into execution, fome 
other means have been thought of 
and employed for reducing corpulency. 
Thefe, if I miftake not, have all been 
certain methods of inducing a faline ftate 
in the mafs of blood ; for fuch I fuppofe 
to be the effects of vinegar and of foap, 
which have been propofed. The latter, 
I believe, hardly, paffes into the bloods 
vefTels, without being refolved and form- 
ed into, a neutral fait, with the acid which 
it meets with in the flomach. How well 
acrid and faline fubftances are fitted to 
diminifh obefity, may appear from what 
has been faid above in (1615). What ef- 
fects vinegar, foap, or other fubftances 
employed, have had in reducing corpu- 
lency, there have not proper opportuni- 
ties of obferving occurred to me : but I 
am well perfuaded, that the inducing 
a faline and acrid (late of the blood, 

may 



OF PHYSIC. ?4 i 

may have worfe confequences than the 
corpulency it was intended to correct ; 
and that no perfon mould hazard thefe, 
while he may have recourfe to the more 
fafe and certain means of abftinence and 
-esercife. 



CHAP. 



24* PRACTICE 



CHAP. II % 



OF 



FLATULENT SWELLINGS. 



1626. ^T^HE cellular texture of the hu- 
■*• man body very readily ad- 
mits of air, and allows the fame to pafs 
from any one to every other part of it. 

Hence 



O F P H Y S I C. 243 

Hence Emphyfemata have often appeared 
from air collected in the cellular texture 
under the fkin, and in feveral other parts 
of the body. The flatulent fwellings un- 
der the fkin, have indeed mod commonly 
appeared in confequence of air immediate- 
ly introduced from without : but in fome 
inftances of flatulent fwellings, efpecially 
thofe of the internal parts not com- 
municating with the alimentary canal, 
fuch an introduction cannot be perceiv- 
ed or fuppofed ; and therefore, in thefe 
cafes, fome other caufe of the production 
and collection of air muft be looked for, 
though it is often not to be clearly afcer- 
tained. 

In every folid as well as every fluid fub- 
flance which makes a part of the human 
body, there is a considerable quantity of 
air in a fixed ftate, which may be agairt 
jeflored to its elaftic flate, and feparated 

from 



^44 PRACTICE 

from thofe fubftances, by the power of 
heat, putrefaction, and perhaps other cau- 
fes : but which of thefe may have produ- 
ced the feveral inftances of pneumatofis 
and flatulent fwellings that have been re- 
corded by authors, I cannot pretend to 
afcertain. Indeed, upon account of thefe 
difficulties, I cannot proceed with any 
clearnefs on the general fubject of pneu- 
matofis ; and therefore, with regard to 
flatulent fwellings, I find it necefTary to 
confine myfelf to the confideration of 
thofe of the abdominal region alone ; 
which I fhall now treat of under the ge^ 
jaeral name of Tympanites. 

1627. The tympanites is a fwelling of 
the abdomen ; in which the teguments 
appear to be much ftretched by fome dif- 
tending power within, and equally ftretch- 
ed in every pofture of the body. The 
fwelling does not readily yield to any 

preffurej 



OF PHYSIC. 245 

preflure ; and in fo far as it does, very 
quickly recovers its former ftate upon the 
preflure being removed. Being ftruck, it 
gives a found like a drum, or other 
ftretched animal membranes. No fluctua- 
tion within is to be perceived ; and the 
whole feels lefs weighty than might be 
expected from its bulk. The uneafinefs 
of the diftention is commonly relieved 
by the difcharge of air from the ali- 
mentary canal, either upwards or down- 
wards. 

1628. Thefe are the characters by which 
the tympanites may be diflinguifhed from 
the afcites or phyfconia ; and many expe- 
riments mow,- that the tympanites always 
depends upon a preternatural collection of 
air, fomewhere within the teguments of 
the abdomen : but the feat of the air is in 
different cafes fomewhat different; and 

this 



246 PRACTICE 

this produces the different fpecies of the 
difeafe. 

One fpecies is, when the air collected is 

entirely confined within the cavity of the 

alimentary canal, and chiefly in that of 

the inteftines. This fpecies, therefore, is 

named the Tympanites inteftinalis, Sauv. fp. 

i. It is, of all others, the mod common; 

and to it efpecially belong the characters 

given above, 

A fecond fpecies is, when the air collec- 
ted is not entirely confined to the cavity of 
the inteftines, but is alfo prefent between 
their coats ; and fuch is that which is na- 
med by Sauvages Tympanites enterophyfodes i 
Sauv. fp. 3. This has certainly been a rare 
occurrence j and has probably occurred 
only in confequence of the tympanites in- 
tejlinalis, by the air efcaping from the 
cavity of the inteftines into the interftices 

of 



OF PHYSIC. 247 

of the coats. It is, however, poflible that 
an erofion of the internal coat of the 
inteftines may give occafion to the air, 
fo conftantly prefent in their cavity, to 
efcape into the interftices of their coats, 
though in the whole of their cavity 
there has been no previous accumula- 
tion. 

A third fpecies is, when the air is col- 
lected in the fac of the peritonaeum, or 
what is commonly called the cavity of the 
abdomen, that is, the fpace between the 
peritonaeum and vifcera ; and then the 
difeafe is named "Tympanites abdominalis r 
Sauv. fp. 2. The exiftence of fuch a tym- 
panites, without any tympanites inteflinalis, 
has been difputed ; and it certainly has 
been a rare occurrence : but from feveral 
diffections, it is unqueftionable that fuch 
a difeafe has fonaetimes truly occurred. 



A 



248 PRACTICE 

A fourth fpecies of tympanites is, when 
the tympanites intejlinalis and abdominalif 
are joined together, or take place at the 
fame time. With refpect to this, it is 
probable that the tympanites intejlinalis is 
the primary difeafe ; and the other, only 
a confequence of the air efcaping, by an 
erofiqn or rupture of the coats of the 
inteftines, from the cavity of thefe into 
that of the abdomen. It is indeed pof- 
fible, that in confequence of erolion or 
rupture, the air which is fo conftantly 
prefent in the inteftinal canal, may efcape 
from thence in fuch quantity into the 
cavity of the abdomen, as to give a 
tympanites abdominalis, whilft there was no 
previous confiderable accumulation of air 
in the inteftinal cavity itfelf ; but I have 
not fads to afcertain this matter pro* 
perly. . 

A fifth fpecies has alfo been enumerat- 
ed. 



OF PHYSIC. 249 

ed. It is when a tympanites abJominahs 
happens to be joined with the hydrops a/ci- 
tes; and fuch a difeafe therefore is nam-, 
ed by Sauvages Tympanites afciticus i Sauv. 
fp. 4. In moft cafes of tympanites, in- 
deed, fome quantity of ferum has, upon 
dhTection, been found in the fac of the 
peritonaeum ; but that is not enough to 
conftitute the fpecies now mentioned, and 
when the collection of ferum is more con- 
fiderable, it is commonly where, both 
from the caufes which have preceded, 
and likewife from the fymptoms which 
attend, the afcites may be confidered as 
the primary difeafe ; and therefore that 
this combination does not exhibit a proper 
fpecies of the tympanites. 

1629. As this laft is not a proper fpe- 
cies, and as fome of the others are not 
only extremely rare, but even, when oc- 
curring, are neither primary, nor to be 

Vol. IV. R eafily 



4.50 PRACTICE 

cafily diftinguifhed, nor, as conficlered in 
themfelves, admitting of any' cure, I mall . 
here take no further notice of them;" 
confining myfelf, in what follows, to the 
confideration of the moft frequent cafe, 
and almoft the only object of pra&ice, the 
tympanites intejlinalis, 

1630. With refpeft to this, I cannot 
perceive that it arifes in any peculiar 
temperament, or depends upon any pre- 
difpofition, which can be difcerned. It 
occurs in either fex, at every age, and fre- 
quently in young perfons. 

1 63 1. Various remote caufes of it have 
been aflignod : but many of thefe have 
not commonly the efFeft nf producing thfc 
difeafe ; and although fome of them have 
been truly antecedents of it, I can in few 
inftances difcover the manner in which 
they produce the difeafe, and therefore 

. cannot 



Of PHYSIC, 251 

cannot certainly afcertaia them to have 
been caufes of it. 

1632. The phenomena of this difeaft 
in its feveral ftages are the following. 

The tumour of the belly fbmetimes 
grows very quickly to a confiderablc 
degree, and feldom in the flow manner 
the afcites commonly comes on. In fome 
cafes, however, the tympanites comes on 
gradually, and is introduced by an unu- 
fual flatulency of the "ftomach and intef- 
tines, with frequent borborygmi, and an 
uncommonly frequent expulfion of air 
upwards and downwards. This ftate is 
alfo frequently attended with colic pains, 
efpecially felt about the navel, and upon 
the fides towards the back ; but generally 
as the difeafe advances ; thefe pains be- 
come lefs confiderable. As the difeafe ad- 
vances, there is a pretty conftant defire to 
R 2 difchargc 



252 PRACTICE 

difcharge air, but it is accomplifhed with 
difficulty : and when obtained, although 
it gives fome relief from the fenfe of dis- 
tention, this relief is commonly tranfient 
and of fhort duration. While the difeafe 
is coming on, fome inequality of tumor 
and tenfion may be perceived in different 
parts of the belly ; but the diftention foon 
becomes equal over the whole-, and ex- 
hibits the phenomena mentioned in the 
character. Upon the firft coming on of 
the difeafe, as well as during its progrefs, 
the belly is bound, and the fasces dis- 
charged are commonly hard and dry. 
The urine, at the beginning, is ufually 
very little changed in quantity or quality 
from its natural flate : but as the difeafe 
continues, it is commonly changed in 
both refpe&s ; and at length fometimes a 
ftranguary, and even an ifchuria, comes 
on. The difeafe has feldom advanced far, 
before the appetite is much impaired, and 
2 digeftion 



O F P H Y S I C. 253 

digeftion ill performed ; and the whole 
body, except the belly, becomes confide- 
rably emaciated. Together with thefe 
fymptoms, a third and uneafy £enfe of 
heat at length comes on, and a coniide- 
rable frequency of pulfe occurs, which 
continues throughout the courfe of the 
difeafe. When the tumor of the belly 
arifes to a considerable bulk, the breath- 
ing becomes very difficult, with a fre- 
quent dry cough. With all thefe fymp- 
toms the ftrength of the patient declines ; 
and the febrile fymptoms daily increafing, 
death at length enfues, fometimes probab- 
ly in confequence of a gangrene coming 
upon the intefhnes. 

1633. The tympanites is commonly of 
fome duration, and to be reckoned a chro- 
nic difeafe. It is very feldom quickly fa- 
tal, except where fuch an affection fud- 
tlenly arifes in fevers. To this Sauvages 
R q; has 



254 PRACTICE 

has properly given a different appellation, 
that of Meteorifmus\ and I judge it may 
always be confidered as a fymptomatic af- . 
fection, entirely diflin<5t from the tympa- 
nites we are now confidering. 

1634. The tympanites is generally a fa- 
tal difeafe, feldom admitting of cure ; but 
what may be attempted in this way, I 
fhall try to point out, after I fhall have 
endeavoured to explain the proximate 
caufe, which alone can lay the foundation 
of what may be rationally attempted for- 
wards its cure- 

1635. To ascertain the proximate caufe 
of tympanites, is fomewhat difficult. It 
has been fuppoied in many cafes, to be 
merely an uncommon quantity of air pre- 
fent in the alimentary canal, owing to the 
extrication and detachment of a greater 
•quantity of air than ufual from the ali- 
mentary 



OF PHYSIC. 2$5 

mentary matters taken in. Our vegetable 
aliments, I believe, always undergo fome 
degree of fermentation ; and in confe- 
quence, a quantity of air is extricated 
and detached from them in the ftomach 
and inteftines : but it appears, that the 
mixture of the animal fluids which our 
aliments meet with in the alimentary 
canal, prevents the fame quantity of air 
from being detached from them that 
would have been in their fermentation 
without fuch mixture j and it is probable 
that the fame mixture contributes alfo to 
the reabforption of the air that had been 
before in fome meafure detached. The 
extrication, therefore, of an unufual quan- 
tity of air from the aliments, may, in 
certain circumftances, be fuch, perhaps, 
as to produce a tympanites ; fo that this 
difeafe may depend upon a fault of the 
digeftive fluids, whereby they are unfit to 
prevent the too copious extrication of air, 
R 4 and 



256 PRACTICE 

and unfit alfo to occafion that reabforption 
of air which in found perfons commonly 
happens. An unufual quantity of air in 
the alimentary canal, whether owing to 
the nature of the aliments taken in, or to 
the fault of the digeftive fluid, does cer- 
tainly fometimes take place ; and may 
poflibly have, and in fome meafure cer- 
tainly has, a {hare in producing certain 
flatulent diforders of the alimentary canal; 
but cannot be fuppofed to produce the tym- 
panites, which often occurs when no pre- 
vious diforder had appeared in the fyftem. 
Even in thofe cafes of tympanites which 
are attended at their beginning with fla- 
tulent diforders in the whole of the ali- 
mentary canal, as we know that a firm 

i 

tone of the inteftines both moderates the 
extrication of air, and contributes to its re- 
abforption or ready expulfion, fo the flatu- 
lent fymptoms which happen to appear at 
the coming on of a tympanites, are, in my 

opinion, 



OF PHYSIC. 257 

opinion, to be referred to a lofs of tone in 
the mufcular fibres of the inteftines, ra- 
ther than to any fault in the digeftive 
fluids. 

1636. Thefe, and other confiderations, 
lead me to conclude, that the chief part 
of the proximate caufe of tympanites, is 
a lofs of tone in the mufcular fibres of the 
inteftines. But further, as air of any 
kind accumulated in the cavity of the 
inteftines fhould even by its own elafti- 
city, find its way either upwards or down- 
wards, and fliould alfo, by the afliftance 
of infpiration, be entirely thrown out 
of the body ; fo, when neither the reab- 
forption nor the expulfion takes plac.~, and 
the air is accumulated fo as to produce 
tympanites, it is probable that the paflfage 
of the air along the courfe of the intes- 
tines is in fome places of thefe interrupted. 
This interruption, however, can hardly 

be 



258 PRACTICE 

be fuppofed to proceed from any other 
caufe than fpafmodic conftrictions in cer- 
tain parts of the canal j and I conclude, 
therefore, that fuch conftrictions concur 
as part in the proximate caufe of tympani- 
tes. Whether thefe fpafmodic conftric- 
tions are to be attributed to the remote 
caufe of the difeafe, or may be confidered 
as the confequence of fome degree of 
atony firft arifing, I cannot with Cer- 
tainty, and do npt find it neceffary to de- 
termine. 

1637. Having thus endeavoured to as- 
certain the proximate caufe of tympanites, 
I proceed to treat of its cure j which 
indeed has feldom fucceeded, and almoft 
never but in a recent difeafe. I mull 
however, endeavour to fay what may 
be reafonably attempted ; what has com- 
monly been attempted j and what at- 
1 tempts 



O F P H Y S I C. 259 

tempts have fometimes fucceeded in the 
cure of this difeafe. 



1638. It muft be a firft indication to 
evacuate the air accumulated in the inte£» 
tines : and for this purpofe it is necefTary 
that thofe conftrictions, which had efpe- 
cially occasioned its accumulation, and 
continue to interrupt its paffage along 
the courfe of the inteftines fhould be re- 
moved* As thefe, however, can hardly 
be removed but by exciting the periftal- 
tic motion in the adjoining portions o£ 
the inteftines, purgatives have been com- 
monly employed - T but it is at the fame 
time agreed, that the more gentle laxa- 
tives only ought to be employed, as the 
more draftie, in the overftretched and 
tenfe ftate of the inteftines, are in danger 
of bringing on inflammation. 

It is for this reafon, alfo, that glyflers 

have 



26o PRACTICE 

have been frequently employed j and they 
are the more neceffary, as the faeces col- 
lected are generally found to be in a hard 
and dry (late. Not only upon account 
of this ftate of the fasces, but, farther, 
when glyflers produce a confiderable eva- 
cuation of air, and thus mow that they 
have fome effect in relaxing the fpafms of 
the inteftines, they ought to be repeated 
very frequently. : 

1639. * n or der to take off the conftric- 
tions of the inte'tines, and with fome 
view alfo to the carminative effects of 
the medicines, various antifpafmodics 
have been propofed, and commonly em- 
ployed ; but their effects are feldom con- 
fiderable, and it is alleged that' their heat- 
ing and inflammatory powers have fome- 
times been hurtful. It is, however, al- 
ways proper to join fome of the milder 
kinds with both the purgatives and gly- 
flers 



O F P H Y S I C 261 

iters that are employed * ; and it has been 
very properly advifed to give always the 
chief of aritifpafmodics, that is, an opi- 
ate, after the operation of purgatives is 
fini/hed. 

1640. In confideration of the over- 
stretched, tenfe, and dry ftate of the 
inteflines, and especially of the fpafmodic 
conftrictions that prevail, fomentations 
and warm bathing have been propofed as 



* The antifpafmodics that are to be joined with pur- 
gatives ought to be effential oils, efpecially the eflential 
oils of umbelliferous plants, as oil of anifeed, oil of ca- 
rui, &.c. and their dofe ought to be moderate. In ma- 
ny cafes, they may be ufed in repeated fmall dofes by 
themfelves on a piece of fugar. The dofe of the ol. ani- 
Fi ought not to exceed ten or twelve drops, nor of the 
ol. carui five drsps; larger dofes are too heating'. It 
v may be proper alfo to obferve, that the effential oils of 
the verticellated plants, as mint, marjoram, thyme, &cc. 
are much too heating, and much more fo thofe of the 
aromatics, as cloves, cinnamon, &c. 



262 PRACTICE 

a remedy ; and are faid to have been em- 
ployed with advantage ; but it has been 
remarked, that very warm baths have not 
been found Co ufeful as tepid baths long 
continued. 

1641. Upon the fuppofition that this 
difeafe depends efpecially upon an atony 
of the alimentary canal, tonic remedies 
feem to be properly indicated. Accord- 
ingly chalybeates, and various bitters, 
have been employed: and, if any atonic *, 
the Peruvian bark might probably be ofa* 
ful. 

1642. But as no tonic remedy is more 
powerful than cold applied to the furface 
of the body, and cold drink thrown into 

' the 

* The author here furely meant to fay tonic; and a- 
tonic feems to be a typographical error ; hut it was ff 
printed in the laft edition publilhed before his death. 



OF PHYSIC. 263 

the ftomach ; fo fuch a remedy has been 
thought of in this difeafe. Cold drink has 
been conftantly prefcribed, and cold bath- 
ing has been employed with advantage ; 
and there have been feveral inftanees of 
the difeafe being fuddenly and entirely 
cured by the repeated application of fnow 
to the lower belly. 

1643. ft ' 1S hardly necefTary to remark, 
that, in the diet of tympanitic perfons, all 
forts of food ready to become flatulent in 
the ftomach are to be avoided : and it is 
probable that the foflil acids and neutral 
falts, as antiyzmics, may be ufeful*. 

1644. In obftinate and defperate cafes 
of tympanites, the operation of the para- 
centetic 

* The foflil acids are undoubtedly very powerful in 
refuting fermentation ; and if the air in the interlines is 
produced by fermentation, they are confequentjy highly 
ufeful. 



264 PRACTICE 

centefis has been propofed: but it is a ve- 
ry doubtful remedy, and there is hardly 
any teftimony of its having been prac"lif- 
ed with fuccefs. It muft be obvious, that 
this operation is a remedy fuited efpecial- 
Iy, and almoft only to the tympanites abdo- 
minalis ; the exiftence of which, feparately 
from the inteftinalis, is very doubtful, at 
leaft not eafily afcertained. Even if its 
exiftence could be afcertained, yet it is not 
very likely to be cured by this remedy : 
and how far the operation might be fafe 
in the tympanites inteftinalis^ is not yet de~ 
termined by any proper experience. 



CHAP. 



OF PHYSIC. 265 



CHAP. III. 



OF 



WATERYSWELLINGS, 



OR. 



DROPSIES. 



1645. A Preternatural collection 

**• of ferous or watery fluids, is 

often formed in different parts of the 

human body; and although the difeafe 

Vol. IV. S thence 



v.66 PRACTICE 

thence arifing be diftinguifhed according 
to the different parts which it occupies, 
yet the whole of fuch collections come 
under the general appellations of Drop- 
lies. At the fame time, although the 
particular inftances of fuch collection are 
to be diftinguifhed from each other ac- 
cording to the parts they occupy, as well 
as by other circumftances attending them ; 
yet all of them feem to depend upon 
fome general caufes, very much in com- 
mon to the whole. Before proceeding, 
therefore, to confider the feveral fpecies, 
it may be proper to endeavour to amgn 
the general caufes of dropfy. 

1646. In perfons in health, a ferous or 
watery fluid feems to be conftantly pour- 
ed out, or exhaled in vapour, into every 
cavity and interftice of the human body 
capable of receiving it ; and the fame fluid, 
without remaining long or being accu- 
mulated 






Of PHYSIC. 167 

initiated in thefe fpaces, feems conftant- 
ly to be foon again abforbed from thence 
by vefTels adapted to the purpofe. From 
this view of the animal ceconomy, it will 
be obvious, that if the quantity poured 
out into any fpace happens to be greater 
than the abforbents can at the fame time 
take up, an unufual accumulation of fe- 
rous fluid will be made in fuch parts ; or 
though the quantity poured out be not 
more than ufual, yet if the abforption be 
any wife interrupted or diminifhed, from 
this caufe alfo an unufual collection of 
fluids may be occafioned. 

Thus, in general, dropfy may be im- 
puted to an increafed effufion, or to a 
diminifhed abforption ; and I therefore 
proceed to inquire into the feveral caufes 
of thefe. 

1647. An increafed effufion may hap- 
S 2 pen, 



268 PRACTICE 

pen, either from a preternatural increafe 
of the ordinary exhalation, or from the 
rupture of vefTels carrying, or of facs con- 
taining, ferous or watery fluids. 

1648. The ordinary exhalation may be 
increafed by various caufes, and particu- 
larly by an interruption given to the free 
return of the venous blood from the ex- 
treme veflels of the body to the right 
ventricle of the heart. This interruption 
feems to operate by refilling the free 
paffage of the blood from the arteries 
into the veins, thereby increafing the 
force of the arterial fluids in the exha- 
halants, and confequently the quantity of 
fluid which they pour out. 

1649. The interruption' of the free re- 
turn of the venous blood from the ex- 
treme vefTels, may be owing to certain 
circumftances affecting the courfe of the 

2 venous 



O F P H Y S I C. 269 

venous blood ; very frequently to certain 
conditions in the right ventricle of the 
heart itfelf, preventing it from receiving 
the ufual quantity of blood from the 
vena cava ; or to obstructions in the vef- 
fels of the lungs preventing ^the entire e- 
vacuation of the right ventricle, and here- 
by hindering its receiving the ufual quan- 
tity of blood from the cava. Thus, a po- 
lypus in the right ventricle of the heart, 
and the omfication of its valves, as well 
as all confiderable and permanent obltruc- 
tions of the lungs, have been found to be 
caufes of dropfy. 

1650. It. may ferve as an illuilration of 
the operation of thefe general caufes, to 
remark, that the return of the venous 
blood is in fome meafure refilled when 
the poflure of the body is fuch as gives 
occafion to the gravity of the blood to 
oppofe the motion . of it in the veins, 
i S3 ,■ i which 



270 PRACTICE 

which takes effect when the force of the 
circulation is weak ; and from whence it 
is that an upright pofture of the body 
produces or increafes ferous fwellings 
in the lower extremities. 

1 65 1. Not only thofe caufes interrupt- 
ing the motion of the venous blood more 
generally, but, farther, the interruption 
of it in particular veins, may likewife 
have the effect of increanng exhalation, 
and producing dropfy. The mofl remark- 
able inftance of this is, when confiderable 
obftructions of the liver prevent the blood 
from flowing freely into it from the vena 
portarum and its numerous branches ; 
and hence thefe obftructions are a fre- 
quent caufe of dropfy. , v 

1652. Schirrofities of the fpleen and 
other vifcera, as well as the fchirrofity of 
the liver, have been confidered as caufes 

of 



OF PHYSIC. 271 

of dropfy; but the manner; in which 
they can produce the difeafe, I do not 
perceive, except - it may be where they 
happen to be near fome confiderable vein, 
by the comprefiion of which they may 
occafion fome degree of afcites ; or, by 
comprefling the vena cava may produce 
an anafarca of the lower extremities. It 
is indeed true, that fchirrofities of the 
fpleen and other vifcera, have been fre- 
quently difcovered in the bodies of hy- 
dropic perfons ; but I believe that they 
have been feldom found, unlefs when 
fchirrofities of the liver were alfo prefent ; 
and I am inclined to think, that the for- 
mer have been the effects of the latter, 
rather than the caufe 6f the dropfy ; or 
that, if fchirrofities of the other vifcera 
have appeared in 'hydropic bodies when 
that of the liver was not prefent, they 
mud have been the effects of fome of thofe 
caufes of dropfy to be hereafter mention- 
S 4 e4 



272 PRACTICE 

ed ; and confequently to be the accidental 
attendants, rather than the caufes, of fuch 
dropfies. 

1653. Ev en infmaller portions of the 
venous fyftem, the interruption of the 
motion of the blood in particular veins 
has had the fame efTed. Thus a poly- 
pus formed in the cavity of a vein, or tu- 
mors formed in its coats, preventing the 
free paflage of the blood through it, have 
had the effect of producing dropfy in 
parts towards the extremity of fuch 



veins-. 



1654. But the caufe mod frequently 
interrupting the motion of the blood 
through the veins is, the compreffion of 
tumours exifting near to them ; fuch as a- 
neurifms in the arteries, abfceffes, and 
fchirrhons or fteatematous tumours in the 
adjoining parts. 

To 



OF PHYSIC. 273 

To this head may be referred the com- 
preflion of the defcending cava by the 
bulk of the -uterus in pregnant women,, 
and the compreflion of the fame by the 
bulk of - water in the afcites ; both of 
which compreffions frequently produce 
ferous fwellings in the lower extremi- 
ties. 

1655. It may be fuppofed that a gene- 
ral preternatural plethora of the venous 
fyftem may have the effect of increafing 
exhalation; and that this plethora may 
happen from the fuppreflion of fluxes, or 
evacuations of blood, which had for fome 
time taken place in the body, fuch as the 
menftrual and hemorrhoidal fluxes. A 
dropfy, however, from fuch a caufe, has 
been at leaft a rare occurrence ; and 
when it feems to have happened, I fhould 
fuppofe it owing to the fame caufes as the 

^fuppreflion 



274 PRACTICE 

fuppr/eflion itfelf, rather than to the 
plethora produced by it. 

1 6s 6. One of the mod frequent caufes 
of an increafed exhalation, I apprehend 
to be the laxity of the exhalant veflels. 
That fuch a caufe may operate, appears 
probable from this, that paralytic limbs, 
in which fuch a laxity is to be fufpected, 
are frequently affected with ferous, or, as 
they are called cedematous fwellings. 

But a much more remarkable and fre- 
quent example of its operation occurs in 
the cafe of a general debility of the fyf- 
tem, which is fo often attended with drop- 
fy. That a general debility does induce 
dropfy, appears fufficiently from its being 
fo commonly the confequence of power- 
fully debilitating caufes ; fuch as fevers, 
either of the continued or intermittent 
kind, which have lafted long ; long-con- 
2 tinned 



OF PHYSIC. 275 

tinued and fomewhat exceflive evacuations 
of any kind.; and, in fhort, almoft all 
difeafes that have been of long continu- 
ance, and have at the fame time induced 
the other fymptoms of a general debility. 

Among other caufes inducing a general 
debility of the fyftem, and thereby drop- 
fy, there is one to be mentioned as fre- 
quently occurring, and that is intempe- 
rance in the ufe of intoxicating liquors ; 
from whence it is that drunkards of all 
kinds, and efpecially dram-drinkers, are 
fo afFe&ed with this difeafe. 

l0 57* That a general debility may pro- 
duce a laxity of the exhalants, will be rea- 
dily allowed ; and that by this efpecially 
it occafions dropfy, I judge from thence, 
that while mofh of the caufes already men- 
tioned are fuited to produce dropfies of 
particular parts only, the Mate of general 

debility 



276 PRACTICE 

debility gives rife to an increafed exhala- 
tion into every cavity and interface of the 
body, and therefore brings on a general 
difeafe. Thus, we have feen effufions of 
a ferous fluid made, at the fame time, 
into the cavity of the cranium, into* that 
of the thorax and of the abdomen, and 
likewife into the cellular texture almoft 
over the whole of the body. In fuch 
cafes, the operation of a general caufe dif- 
- covered itfelf, by thefe feveral dropfies in- 
creasing in one part as they diminifhed in , 
another, and this alternately in the dif- 
ferent parts. This combination, therefore, 
of the different fpecies of dropfy, or ra- 
ther, as it may be termed, this univerfal 
dropfy, muft, I think, be referred to a 
general caufe ; and in moft inftances, 
hardly any other can be thought of, but 
a general laxity of the exhalants. It is 
this, therefore,, that I call the hydropic 
(licithcfu; which frequently operates by 

itfelf; 



■ O F P H Y S I C. 277 

itfelf ; and frequently, in fome meafure, 
concurring with other caufes, is efpecial- 
ly that which gives them their full ef- 
fect. 

This ftate of the fyftem, in its firft ap- 
pearance, feems to be what has been con- 
fidered as a particular difeafe under the 
name of Cachexy; but in every inftance 
of it that has occurred to me, I have 
always confidered, and have always found, 
irTto be the beginning of general drop- 

1658. The feveral caufes of dropfy al- 
ready mentioned may produce the difeafe, 
although there be no preternatural abun- 
dance of ferous or watery fluid in the 
blood- veffels ; but it is now to be remark- 
ed, that a preternatural abundance of that 
kind may often give occafion to the dif- 
eafe, and more efpecially when fuch abun- 
dance 



278 PRACTICE 

dance concurs with the caufes above enu* 
merated. 

One caufe of fuch preternatural abun- 
dance may be an unufual quantity of wa- 
ter taken into the body. Thus an unufu- 
al quantity of water taken in by drink- 
ing, has fometimes occafioned a dropfy. 
Large 'quantities of water, it is true, are 
upon many occafions taken in; and being 
as readily thrown out again by ftool, u- 
rine, or perfpiratibri, have riot produced 
any difeafe. But it is alfo certain, that, 
upon fome occafions, an unufual quanti- 
ty of watery liquors taken in has ruii off 
by the feveral internal exhalants, and pro- 
duced a dropfy. This feems to have hap- 
pened, either from the excretories not be- 
ing fitted to throw out the fluid fo faft 
as it had been taken in, or from the ex- 
cretories having been obftrudled by acci- 
dentally concurring caufes; Accordingly 

it 



OF PHYSIC. 279 

it is faid, that the fudden taking in of a 
large quantity of very cold water, has 
produced dropfy, probably from the 
cold producing a eonftriction of the ex- 
cretories. 

The proportion of watery fluid in the 
blood may be increafed, not only by the 
taking in a large quantity of water by 
drinking, as now mentioned, but it is 
poflible that it may be increafed alfo by 
water taken in from the atmofphere by 
the fkin in an abforbing or imbibing ftate. 
It is well known that the fkin may be, at 
leaft, occafionally in fuch a llate ; and it 
is probable, that in many cafes of begin- 
ning dropfy, when the circulation of the 
blood on the furface of the body is very 
languid, that the ikin may be changed 
from a perfpiring to an imbibing ftate ; 
and thus, at leaft, the difeafe may be ve- 
ry much increafed. 

1659, A 



2$o PRACTICE » 

1659. A fecohd caufe of a preternatural 
abundance of watery fluids in the blood- 
vefTels, may be, an interruption of the or- 
dinary watery excretions ; and according- 
ly it is alleged, that perfons much expof- 
cd to a cold and moift air are liable to 
dropfy. It is alfo faid, that an interrup- 
tion, or confiderable diminution, of the 
urinary fecretion, has produced the di£- 
cafe : and it is certain, that in the cafe of 
an ifchuria renalis, the ferofity retained 
in the blood-veflels has been poured out 
into fome internal cavities, and has occa- 
sioned dropfy. 

1660. A third caufe, of an over-pro- 
portion of ferous fluid in the blood ready 
to run off by the exhalants, has been ve-* 
ry large evacuations of blood, either fpon- 
taneous or artificial. Thefe evacuations, 
by abftracTmg a large proportion of red 
globules and gluten, which are the prin- 
cipal 



OF PHYSIC. 281 

cipal means of retaining ferum in the red 
veffels, allow the ferum to run off more 
readily by the exhalants ; and hence drop- 
fies have been frequently the confequence 
of fuch evacuations. 

It is pomble alfo, that large and long- 
continued iflues, by abftracting a large 
proportion of gluten, may have the fame 
effed. ' 

An over proportion of the ferou-g parts 
of the blood may not only be owing to the 
/puliation juft now mentioned, but may, 
I apprehend, be likewife owing to a fault 
in the digefting and aflimilating powers in 
the flomach and other organs ; whereby 
they do not prepare and convert the ali- 
ments taken in, in fuch a manner* as to 
produce from them the due proportion of 
red globules and gluten j but (till conti- 
nuing to fupply the watery parts, Occa- 

Vol. IV. T fion 



282 PRACTICE 

fion thefe to be in an over-proportion, 
and confequently ready to run off in too 
large quantity by the exhalants. It is in 
this manner that we explain the dropfy, 
fo often attending chlorosis : which ap- 
pears always at firft by a pale colour of 
the whole body, fhowing a manifeft de- 
ficiency of red blood ; which in that dif- 
eafe can only be attributed to an imperfect 
digestion and aflimilation. 

Whether a like imperfection takes place 
in what has been called a Cachexy, I dare 
not determine. This difeafe indeed has 
been commonly and very evidently owing 
to .the general caufes of debility above 
mentioned : and it being probable that 
the general debility may affect the organs 
of digeftion and aflimilation ; fo the im- 
perfect flate of thefe functions, occafion- 
ing.a deficiency of red globules and glu- 
ten, 



OF PHYSIC. 283 

ten, may often occur with the laxity of 
the exhalants in producing dropfy. 

1 661. Thefe are the feveral caufes of 
increafed exhalation, which I have men- 
tioned as the chief caufe of the effufion 
producing dropfy; but I have likewife 
obferved in 1647, that with the fame 
effect, an effufion may alfo be made by 
the rupture of veffels carrying watery 
fluids. 

In this way, a rupture of the thoracic 
.duct, has given occafion to an effufion of 
chyle and lymph into the cavity of the 
thorax ; and a rupture of the lacteals has 
occafioned a like effufion into the cavity 
of the abdomen ; and in either cafe, a 
dropfy has been produced. 

It is fufficiently probable, that a rup- 
ture of lymphatics, in confrquenee of 
T 2 ftrains, 



284 PRACTICE 

ftrains, or the violent compreflion of 
neighbouring mufcles, has occafioned an 
effufion ; which being diffufed in the cel- 
lular texture, has produced dropfy. 

It belongs to this head of caufes, to re- 
mark, that there are many inftances of a 
rupture or erofion of the kidneys, ureters, 
and bladder of urine ; whereby the urine 
has been poured into the cavity of t;he ab- 
domen, and produced an afcites. 

1662. Upon this fubjecT:, of the rup- 
ture of veffels carrying, or of veficles con- 
taining, watery fluids, I muft obferve, 
that the diflection of dead bodies has of- 
ten fliowri veiicles formed upon the fur- 
face of many of the internal parts ; and 
it has been fuppoTed, that the rupture of 
fuch veficles, cornmonly named Hydatides t 
together with their continuing to pour out 
a watery fluid, has been frequently the 

caufe 



OF PHYSIC. 2S5 , 

caufe of dropfy. I cannot deny the pof- 
fibility of fuch a caufe, but fufpect the 
matter mull be explained in a different 
manner. 

There have been frequently found, in 
almoft every different part of animal bo- 
dies, collections of fpherical veficles, con- 
taining a watery fluid ; and in many 
cafes of fuppofed dropfy, particularly in. 
thole called the preternatural encyfled 
dropfies, the fwelling has been entirely 
.owing to a collection of fuch hydatides. 
Many conjectures have been formed 
with regard to the nature and production 
of thefe veficles ; but the matter at lad 
feems to be afcertained* It feems to be 
certain, that each of thefe veficles has 
within it, or annexed to it, a living ani- 
mal of the worm kind ; which feems to 
have the power of forming a veficle for 
the purpofe of its own ceconomy, and of 
T 3 filling 



286 PRACTICE 

filling it with a watery fluid drawn from 
the neighbouring parts : and this animal 
has therefore been properly named by 
late naturalifts, the Taenia hydatigena. The 
origin and (Economy of this animal, or 
an account of the feveral parts of the 
human body which it occupies, I cannot 
profecute further here ; but it was proper . 
for me, in delivering the caufes of dropfy, 
to fay thus much of hydatides : and I 
mud conclude with obferving, I am well 
perfuaded, that molt of the inftances of 
preternatural encyfted dropfies which 
have appeared in many different parts of 
the human body, have been truly collec- 
tions of fuch hydatides ; but how the 
fwellings occafioned by thefe are to be 
diftinguiflied from other fpecies of drop- 
fy, or how they are to be treated in prac- 
tice, I cannot at prefent determine. 

1663. After having mentioned thefe, 

I 



O F P H Y S I C 287 

I return to confider the other general 
caufe of dropfy, which I have faid in 
1646, may be, An interruption or dimi- 
nution of the abforption that fhould take 
up the exhaled fluids from the feveral 
cavities and interfaces of the body ; the 
caufes of which interruption, however, 
are not eafily afcertained. 

1664. It feems probable, that abforp- 
tion may be diminiihed, and even ceafe 
altogether, from a lofs of tone in the ab- 
forbent extremities of, the lymphatics, I 
cannot indeed doubt that a certain degree 
of tone or active power is neceflary in 
thefe abforbent extremities ; and it -ap- 
pears probable, that the fame general de- 
bility which produces that laxity of the 
exhalant verbis, wherein I have fuppofed 
the hydropic diathefis to confift, will at 
the fame time occafion a lofs of tone in 
the abforbents ; and therefore that a 
T 4 laxity 



288 PRACTICE 

laxity of the exhalants will generally be 
accompanied with # lofs of tone in the 
abforbents ; and that this will have a fhare 
in the production of dropfy. Indeed it 
is probable that the diminution of ab- 
forption has a confiderable fhare in the 
matter ; as dropfies are often cured by 
medicines which feem to operate by ex^ 
citing the action of the abforbents. 

1665. It has been fuppofed, that the 
abforption performed by the extremities 
of lymphatics may be interrupted by an 
obftru&ion of thefe vefTels, or at leaft of 
the conglobate glands through which 
thefe vefTels pafs. This, however, is 
very doubtful. As the lymphatics have 
branches frequently communicating with 
one another, it is not probable that the 
obftruclion of any one, or even feveral 
of thefe can have any confiderable effedt 

in 



OF PHYSIC. 289 

in interrupting the abforption of their ex- 
tremities. 

And for the fame reafon, it is as little 
probable that the obftruction of conglo- 
bate glands can have fuch an effect : at 
leafl it is only an obflru<5tibn of the 
glands of the mefentery, through which 
fo confiderable a portion of the lymph 
paffes, that can pofhbly have the effect 
of interrupting abforption. But even 
this we mould not readily fuppofe, there 
being reafon to believe that thefe glands, 
even in a confiderable tumefied ftate, are 
not entirely obftructed : And according- 
ly I have known feveral inflances of the 
moft part of the mefenteric glands being 
confiderably tumefied, without either in- 
terrupting the tranfmifiion of fluids to' 
the blood-veffels, or occafioning any drop- 

An 



290 PRACTICE 

An hydropic fwelling, indeed, feems 
often to affect the arm from a tumor of 
the axillary gland; but it feems to me 
doubtful, whether the tumor of the arm 
may not be owing to fome compreffion 
of the axillary vein rather than to an ob- 
flruction of the lymphatics. 

1666. A particular interruption of 
abforption may be fuppofed to take place 
in the brain. As no lymphatic veffels 
have yet very certainly been difcovered 
in that* organ, it may be thought that 
the abforption, which certainly takes 
place there, is performed by the extremi- 
ties of veins, or by'veflels that carry the 
fluid directly into the veins ; fo that any 
impediment to the free motion of the 
blood in the veins of the brain,' may in- 
terrupt the abforption there, and occafion 
that accumulation of ferous fluid which 
fo frequently occurs from a congeftion 

of 



OF PHYSIC. 2 9 i 

of blood in thefe veins. But 1 give all 
this as a matter of conjecture only. 

1667. Having thus explained the 
general caufes of dropfy, I mould pro- 
ceed, in the next place, to mention the 
feveral parts of the body in which 
ferous collections take place, and fo to 
mark the different fpecies of dropfy: 
but I do not think it neceffary for me 
to enter into any minute detail upon 
this fubject. In many cafes thefe col- 
lections are not to be afcertained by 
any external fymptoms, and therefore 
cannot be the objects of practice; and 
many of them, though in fome meafure 
difcernible, do not feem to be curable 
by our art. I the more efpecially avoid 
mentioning very particularly the feve- 
ral fpecies, becaufe that has already been 
fufficiently done by Dr D. Monro and 
Other writers, in every body's hands. I 

imjit 



292 PRACTICE 

muft confine myfelf here to the con- 
fideration of thofe fpecies which are 
the mod frequently occurring and the 
moft common objects of our practice ; 
which are, the Anafarca, Hydrotho- 
rax, and Afcites ; and each of thefe I 
{hall treat of in fo many feparate fections. 



SECT, 



O F P H Y S I C. 293 



S E C T. ■ I. 



OF 



ANASARCA, 



1668. The Anafarcs is a fwelling upon 
the furface of the body, at firft commonly 
appearing in particular parts only, but 
at length frequently appearing over the 

whole. 



294 PRACTICE 

whole. So far as it extends, it is an uni- 
form fwelling over the whole member, at 
firfi: always foft, and readily receiving the 
prefTure of the finger, which forms a hol- 
low that remains for fome little time after 
the prefTure is removed, but at length rifes 
again to its former fulnefs. This fwel- 
ling generally appears, firft, upon the low- 
er extremities j and there too only in the 
evening, difappearing again in the morn- 
ing. It is ufualry more confiderable as 
the pet fon has been more in an erect pof- 
ture during the day i but there are many 
inftances of, the exercife of walking pre- 
venting altogether its otherwife ufual com- 
ing on. Although this fwelling appears 
at firft only upon the feet and about the 
ankles ; yet if the caufes producing it con- 
tinue to act, it gradually extends upwards, 
occupying the legs, thighs, and trunk of 
the body, and fometimes even the head. 
Commonly the fwelling of the lower ex- 
tremities 



OF PHYSIC, 295 

tremities diininhlies during the night; 
and in the morning, the fwelling of the 
face is moft considerable, which again 
generally difappears almoft entirely in the 
eourfe of the day. 

1669. The terms of Anafarca and Leu- 
eophlegmatia have been commonly confi- 
dered as fynonymous ; but fome authors 
have propofed to conlider them as denot- 
ing diftincT; difeafes. The authors who 
are of this laft opinion employ the name 
of Anafarca for that difeafe which begins 
in the lower extremities, and is from 
thence gradually extended upwards in the' 
manner I have juft now deicribed j while 
they term Leucophkgmatia y that in which 
the fame kind of fweljing appears even 
at firft very generally over the whole 
body. They feem to think alfo, that the 
two difeafes proceed from different caufes ; 
and that, while the anafarca may a-rife 
2 from 



2<;6 PRACTICE 

from the feveral caufes in 1648, 1659, tne 
Ieucophlegmatia proceeds especially from 
a deficiency of red blood, as we hav* men- 
tioned in 1660, et feq. I cannot, however, 
find any proper foundation for this dis- 
tinction. For although in dropfies pro- 
ceeding from the caufes mentioned in 
1 660, et feq. the difeafe appears in fome 
cafes more immediately affecting the whole 
body ; yet that does not eftablifh a 
difference from the common cafe of ana- 
farca: for the difeafe, in all its circum- 
ftances, comes at length to be entirely the 
fame ; and in cafes occafioned by a defi- 
ciency of red blood, I have frequently 
obferved it to come on exactly in the 

manner of anafarca, as above defcribed* 
1 

1670. An anafarca is evidently a pre- 
ternatural collection of ferous fluid in the 
cellular texture immediately under the 
(kin. Sometimes pervading the fkin it- 

felf. 



OF PHYSIC. 297 

felf, it oozes dut through the pores of the 
cuticle ; and fometimes, too grofs to pafs 
by thefe, it raifes the cuticle in blifters. 
Sometimes the {kin, not allowing the wa- 
ter to pervade it, is comprefTed and har- 
dened, and at the fame time fo much dif- 
tended, as to give anafarcous tumours an 
unufual firmnefs. It is in thefe laft cir- 
cumftances alfo that an erythematic in- 
flammation is ready to come upon anafar- 
cous fwellings. 

1 67 1. An anafarca may immediately a- 
rife from any of the feveral caufes of drop- 
fy, which act more generally upon the fyf- 
tem : and even when other fpecies of drop- 
fy, from particular circumstances, appear 
fir ft ; yet whenever thefe proceed from a- 
ny caufes more generally affecting the 
fyftem, an anafarca fooner or later comes 
always to be joined with them. 

Vol. IV.' U. 1672. The 






29S P R A C T I C E 

1672. The manner in which this difeaffc 
commonly firft appears, will be re'adily 
explained by what I have faid in 1650, 
refpecting the effects of the pofture of the 
body. Its gradual progrefs, and its af- 
fecting, after fome time, not only the 
cellular texture under the fkin, but pro- 
bably alfo much of the fame texture in 
the internal parts, will be underftood 
partly from the communication that is 
readily made between the feveral parts of 
the" cellular texture: but efpecially from 
the fame general caufes of the difeafe pro- 
ducing their effects in every part of the 
body. It appears to me, that the water 
of anafarcous fwellings is more readily 
communicated to the cavity of the tho- 
rax, and to the lungs, than to the cavity 
of the abdomen, or to the vifcera contain?. 
ed in it. 

1673. An 



OF PHYSIC. 299 

1673. An anafarca is almoft always at- 
tended with a fcarcity of urine ; and the 
urine voided, is, from its fcarcity, always 
of a high colour; and, from the fame 
caufe, after cooling, readily lets fall a 
copious reddifh fediment. This fcarcity 
of urine may fometimes be owing to an 
obftruction of the kidneys ; but probably 
is generally occasioned by the watery parts 
of the blood running off into the cellular 
texture, and being thereby prevented 
from pamng in the ufual quantity to the 
kidneys. 

The difeafe is alfo generally attended 
with an unufual degree of'thirfl; a cir- 
cumftance I would attribute to a like 
abftradion of fluid from the tongue and 
fauces, which are extremely fenfible to 
every diminution of, the fluid in thefe 
parts. 

u 2 i6 74 . The 



3 oo PRACTICE 

1674. The cure of anafarca is to 
be attempted upon three general indica- 
tions. 

i. The removing the remote caufes of 
the difeafe. 

1. The evacuation of the ferous fluid 
already coHedted in the cellular tex- 
ture. 

3. The reftoring the tone of the fyftem, 
tile lofs of which may be confidered in 
many cafes as the proximate caufe of the 
difeafe. 

1675. The remote caufes are very often 
fuch as had not only been applied, but 
had a x lfo'been removed*, long before the 

difeafe 

* Thefe are large evacuations of different kinds, but 

especially 



OF PHYSIC. 301 

difcafe came on. Although, therefore, 
their effects remain, the caufes themfelves 
cannot be the object of pradice; but if 
the caufes flill continue to be applied, 
fuch as intemperance, indolence, and 
fome others, they muft be removed. For 
-the moft part, the remote caufes are cer- 
tain difeafes, previous to the dropfy, 
which are to be cured by the remedies 
particularly adapted to them, anfl cannot 
be treated of here. The curing of thefe, 
indeed, may be often difficult ; but it 
was proper to lay down the prefent indi- 
cation, in order to fhow, that when thefe 
remote caufes cannot be removed, the cure 
of the dropfy muft be difficult, or perhaps 
impomble. In many cafes, therefore, the 
following indications will be to little 
purpofe : and particularly, that often the 
U 3 execution 

efpecially hsemorrhagies, which have ceafed before the 
dropfy came on. 



3o'i PR A CTICE 

execution of the fecond will not only givg 
the patient a great deal of fruitlefs trou* 
ble, but commonly alfo hurry on his 
fate. 

1676. The fecond indication for evacu- 
ating the collected ferum, may be fome-* 
times executed with advantage, and of- 
ten, at leaft, with temporary relief. It 
may be performed in two ways. Firfl, 
by drawing off the water directly from 
the dropfical part, by openings made in- 
to it for that purpofe : Or, fecondly, by 
exciting certain ferous excretions ; in con- 
fequence of which, an abforption may be 
excited in the dropfical parts, and there- 
by the ferum abforbed and carried into 
the blood- veffels, may be afterwards direct- 
ed to run out, or may fpontaneoufly pafs 
out, by one or other of the common ex- 
cretions. 

1677. In 



(JF PHYSIC. 303 

1677. In an anafarca, the openings 
into the dropfical part are commonly to 
be made in fome part of the lower ex- 
tremities ; and will be moft properly 
made by many fmall punctures reaching 
the cellular texcure. Formerly, confider- 
able incifions were employed for this pur- 
pofe : but as any wound made in drop- 
fical parts, which, in order to their heal- 
ing, muft neceflarily inflame and fuppu- 
rate, are liable * to become gangrenous ; 
fo it is found to be much fafer to make 
the openings by fmall pundures only, 
which may heal up by the firft intention. 
At the fame time even with refpecl to 
thefe punctures, it is proper to obferve, 
that they fhould be made at fome dis- 
tance from one another, and that care 
U 4 mould 

* Peculiarly- liable in this difeafe on account of the 
'diminifhed tone and confequently the dirbinifhed 
ftrength of the parts. 



3 04 PRACTICE 

fhould be taken to avoid them in the 
moft depending parts. 

1678. The water of anafarcous limbs 
may be, fometimes drawn off by pea- 
iffues, made by cauftic a little below the 
knees : for as the great fwelling of the 
lower extremities is chiefly occafioned 
by the ferous fluid exhaled into the up- 
per parts conftantly falling down to the 
lower: fo the ilTues now mentioned, by 
evacuating the,water from the upper parts, 
may very much relieve the whole of the 
difeafe. Unlefs, however, the iffues be 
put in before the difeafe is far advanced, 
and before the parts have very much 
loll their tone, the places of the iffues 
are ready to become affected with gan- 
grene. 

Some practical writers have advifed 
the employment of fetons for the fame 

purpofe 



, OF PHYSIC. 305 

purpofe that I have propofed ifTues ; but 
I apprehend, that fetons will be more 
liable than ifTues to the accident juft 
now mentioned. 

1 679. For the purpofe of drawing out 
ferum from anafarcous limbs, blifters 
have been applied to them, and fome- 
times with great fuccefs ; but the blifter- 
ed parts are ready to have a gangrene 
come upon them. Bli tiering is therefore 
to be employed with great caution ; and 
perhaps only in the circumflances that 
I have mentioned above to be fit for the 
employment of iiTues. 

1680. Cole wort-leaves applied to the 
fkin, readily occafion a watery exfudation 
from its furface ; and applied to the 
feet and legs affected with anafarca, have 
fometimes drawn off the water very co- 
pioufly, and with great advantage. 

Analagous, 



3 o6 PRACTICE 

Analagous, as I judge, to this, oiled 
filk-hofe put upon the feet and legs, fo 
as to fhut out all communication with 
the external air, have been found 
fometimes to draw a quantity of water 
from the pores d£ the fkin, and are faid 
in this way to have relieved anafarcous 
fwellings : but in feveral trials made, I 
have never found either the application 
of thefe hofe, or that of the colewort- 
leaves, of much fervice *. 

1 68 1. The 2d nteans propofed in 1676. 
for drawing off the water from dropfical 
places, may be the employment of eme- 
tics, purgatives, diuretics, or fudorifics. 

1682. As fpontaneous vomiting has 

fometimes 

* How does this lafl: agree with the firil feritence of 
this article? 



O F P H Y S I C. 307 

fometimes excited an abforption in 
hydropic parts, and thereby drawn off 
the waters lodged , in them, it is reafon- 
able to fuppofe that vomiting excited by 
art may have the fame effect ; and accord- 
ingly it has been often practifed with 
advantage. The practice, however, re- 
quires that the flrong antimonial emetics 
be employed, and that they be repeated 
frequently after fhort intervals. 

1683. Patients fubmit more readily to 
the ufe of purgatives, than to that of 
emetics ; and indeed they, commonly bear 
the former more eafily than the latter. 
At the fame time, there are no means 
we can employ to procure a copious 
evacuation of a ferous fluid with 
greater certainty than the operation of 
purgatives, and it is upon thefe ac- 
counts that purging is the evacuation 
which has been moft frequently, and 

perhaps 



308 PRACTICE 

perhaps with mod fuccefs, employed in 
dropfy. It has' generally been found ne- 
ceflary to employ purgatives tȣ the more 
draftic kind ; which are commonly 
known, and need not be enumerated 
here *, I believe, indeed, that the more 

draftic 

* The Draftic purgatives are Jalap, Colocynth, 
Gambpge, Scammony, &.c. Their draftic quality how- 
ever depends very much on the dofe in which they are 
given, fmall dofes being gently laxative, while large 
ones are very violent in their operation. They ought 
feldom to be given alone, but in conjunction with fome 
aromatic, which greatly increafes their aftion, and at 
the fame time prevents the uneafinefs of griping, with 
which their operation is frequently attended : moft of 
thefe draftics being refinous fubftances, they are diffi- 
cultly fallible' in the alimentary canal, or if reduced to 
a powder they are liable to concrete ; in either cafe, 
their a£lion is impeded. To remedy thefe inconveni- 
encies, it is ufual to add to them fome fait, which both 
disudes the refin and prevents its concretion ; and con- 
fequently increafes its. aftion. For thefe reafons, we 
find in the {hops many formulae, in which the draftic 

refins 



OF PHYSIC. 309 

draflic purgatives are the moll effec- 
tual for exciting • abforption, as their 
ftimulus is mod readily communicated' 

to 

refins are mixed with either falts or aromatics, or both : 
As, the Pulvis Aloeticus, Pulvis e Scammonio compo- 
fitus, Pulvis e Scammonio cum Aloe, Pulvis e fenna 
compofitus, and Elecluarium e Scammonio of the Lon- 
don Pharmacopoeia ; and the Pulvis Jalappae compofitus, 
Pulvis Scammonii- compofitus, Pilulse Aloeticae, Pilulae 
Aloes cum colocynthide, and Pilulse Aloes cum myrrh, 
of the Edinburgh Pharmacopoeia. 

Any of the foregoing compofitions, if given in fuffi- 
cient dofes, are very afti've and brifk purges. Many 
more might be contrived, and on fome occafions may be 
neceflary. For procuring a brifk difcharge of fluids, 
an addition of Calomel is remarkably efficacious as in- 
the following formula : 

R. Scammon. 
Calomel. 
Crem. Tart. 
Zinzib aa. p. se. 
M. f. pulv. 

The 



3 To PRACTICE 

to the other parts of the fyftem ; but of 
late an opinion has prevailed, that fome 
milder purgatives may be employed with 
advantage. This opinion has prevailed 
particularly with regard to the cryftals 
vulgarly called the Cream, of Tartar, 
which in large dofes, frequently repeated, 
have fometimes anfwered the purpofe of 
exciting large evacuations both by ftool 
and urine, and has thereby cured drop^ 
fies. This medicine, , however, has fre- 
quently failed, both in its operation and 
effects, when the draftic purgatives have 
been more fuccefsful. 

Practitioners have long ago obferved, 
that, in the employment of purgatives, 

it 

The dofe of this powder is two fcruples or a drachm :> 
it is extremely a£tive and ought to be ufed with Clare, 
the patients being kept moderately warm, and drinking 
ibtne thin mucilaginous liquor during its operation. 



OF PHYSIC. 311 

it is requifite they be repeated after as 
fhort intervals as the patient can bear ; 
probably for this reafon; that when the 
purging is not carried to the degree of 
foon exciting an abforption, the evacua- 
tion weakens the fyftem, and thereby in- 
creafes, the afflux of fluids to the hydropic 
parts. 

1684. The kidneys afford a natural 
outlet for a great part of the watery fluids 
contained in the blood- vefTels ; and the 
increafing the excretion by the kidneys to 
a confiderable degree, is a means as like- 
ly as any other of exciting an abforption 
in dropfical parts. It is upon this ac- 
count that diuretic medicines have been 
always properly employed in the cure of 
dropfy. The various diuretics that may- 
be employed, are enumerated in every 
treatife of the Materia Medica and of the 
Practice of Phyfic, and therefore need not 

be 



yi PRACTICE 

be repeated here. It happens, however, 
unluckily, that none of them are of very- 
certain operation ; neither is it well known 
why they fometimes fucceed, and why 
they fo often fail ; nor why one medicine 
fhould prove of fervice when another 
does not. It has been generally the fault 
of writers upon the Practice of Phyfic, 
that they give us inftances of cafes in 
which certain medicines have proved 
verv efficacious, but neglect to tell us in 
how many other inftances the fame 
have failed. 

1685. It deferves to be particularly 
obferved here, that there is hardly any 
diuretic more certainly powerful than a 
large quantity of common water taken 
in by drinking. I have indeed obferved 
above in 1658, that a large quantity of 
water, or of watery liquors, taken in by 
drinking, has fometimes proved a caufe 

3 of 



OF PHYSIC. 313 

of dropfy; and practitioners have been 
formerly fo much afraid that watery 
liquors taken in by drinking might run 
off into dropfical places and increafe the 
difeafe, that they have generally enjoined, 
the abftaining as much as poilible, from 
fuch liquors. Nay it has been further 
afferted, that by avoiding this fupply 
of exhalation, and by a total abftinence 
from drink, dropfies have been entirely 
cured. What conclusion is to be drawn 
from thefe facts is, however, very doubt- 
ful. A dropfy arifing from a large quan- 
tity of liquids taken in to the body has 
been a very rare occurrence ; and there 
are, on the other hand, innumerable in- 
flances of very large quantities of water 
having been taken in, and running off 
again very quickly by (tool and urine, 
without producing any degree of dropfy. 
With refpect to the total abftinence from 
drink, it is a practice of the mod dif- 
Vol. IV. X ficult 



314 PRACTICE 

ficult execution ; and therefore has been 
fo feldom practifed, that we cannot 
poflibly know how far it might prove 
effectual. The practice of giving drink 
very fparingly, has indeed been often 
employed : but in an hundred inftances 
1 have feen ' it carried to a great length, 
without any manifeft advantage ; while, 
on the contrary, the practice of giving 
drink very largely has been found not 
only fafe, but very often effectual in cur- 
ing the difeafe. The ingenious and learn- 
ed Dr. N4illman has, in my opinion, been 
commendably employed in reftoring the 
practice of giving large quantities of 
watery liquors for the cure of dropfy. 
Not only from the inftances he mentions 
from his own practice, and from that of 
feveral eminent phyficians in other parts 
of Europe, but alfo from many inftances 
in the records of phyfic, of the good 
effects of drinking large quantities of 

mineral 



O F P H Y S I C. 315 

mineral waters in the cure of dropfy, I 
can have no doubt of the practice recom- 
mended by Dr. Millman being very of- 
ten extremely proper. I apprehend it to 
be efpecially adapted to thofe cafes in 
which the cure is chiefly attempted by 
diuretics. It is very probable that thefe 
medicines can hardly be carried in any 
quantity to the kidneys without being 
accompanied with a large portion of 
water ; and the late frequent employ- 
ment of the cryflals of tartar has often 
fhown, that the diuretic effects of that 
medicine are almoft only remarkable when 
accompanied with a large quantity of wa- 
ter; and that without this, the diuretic 
effects of the medicine feldom appear. 
I fhall conclude this fubjecl with obferv- 
ing, that as there are fo many cafes of 
dropfy abfolutely incurable, the practice 
now under conlideration may often fail, 
yet in moft cafes it may be fafely tried ; 
X 2 / and 



o 



\6 PRACTICE 



and if it appear that the water taken in 
pafles readily by the urinary fecretion, 
and efpecially that, it increafes the urine 
beyond the quantity of drink taken in, 
the practice may probably be continued 
with great advantage : but on the con- 
trary, if the urine be not increafed, or be 
not even in proportion to the drink taken 
in, it may be concluded, that the water 
thrown in runs off by the exhalants, and 
will augment the difeafe. ^ 

1686. Another fet of remedies which 
may be employed for exciting a ferous 
excretion, and thereby curing dropfy, is 
that of fudorifics. Such remedies, indeed, 
have been fometimes employed; but how- 
ever ufeful they may have been thought, 
there are few accounts of their having e£- 
fecled a cure ; and although I have had 
fome examples of their fuccefs, in moft 

instances 



OF PHYSIC. 317 

inftances of their trial they have been in- 
effectual. 



Upon this fubjecT: it is proper to take 
notice of the feveral means that have been 
propofed and employed for diiTipating the 
humidity of the body ; and particularly 
that of heat externally applied to the fur- 
face of it. Of fuch applications I have 
had no experience: and their propriety 
and utility mud reft upon the credit of 
the authors who relate them. I fhall of- 
fer only this conjecture upon the fubjecT:. 
That if fuch rneafures have been trueiy 
ufeful, as it has feldqm been by the draw- 
ing out of any fenfible humidity, it has 
probably been by their reftoring the per- 
foration, which is fo often greatly dimi- 
nifhed in this difeafe ; or, perhaps, by 
changing the ftate of the fiun, from the 
imbibing condition which is alleged to 
take place, into that of perfpiring. 

X3 , 1687. When 



3i8 P R A C T I C E 

1687. When by the feveral means now- 
mentioned, we fhall have fuccceded in e- 
vacuating the water of dropfies, there 
will then efpecially be occafion for our 
third indication, which is, to reftore the 
tone of the fyftem, the lofs of which is fo 
often the caufe of the difeafe. This indi- 
cation, indeed, may properly have place 
from the very firft appearance of the dif- 
eafe ; and certain meafures adapted to 
this purpofe may, upon fuch firft appear- 
ance, be employed with advantage. In 
many cafes of a moderate difeafe, I am per- 
fuaded that they may obviate any future 
increafe of it. 

1688. Thus, upon what is commonly 
the firft fymptom of anafarca, that is, u- 
pon the appearance of what are called Oe- 
dematous Swellings of the feet and legs, 
the three remedies of bandaging, friction, 

and 



OF PHYSIC. 319 

and exercife, have often been ufed with 
advantage. 

1689. That fome degree of external 
compreflion is fuited to fupport the tone 
of the veffels, and particularly to prevent 
the effects of the weight of the blood in 
dilating thofe of the lower extremities, 
muft be fufficiently evident ; and the giv- 
ing that compreflion by a bandage pro- 
perly applied, has been often ufeful. In 
applying fuch a bandage, care is to be ta- 
ken that the compreflion may never be 
greater on the upper than on the lower 
part of the limb ; and this, I think, can 
hardly ever be fo certainly avoided, as by 
employing a properly conftructed laced 
flocking. 

1 690. Friction is another means by 
which the action of the blood-vefTels may 
be promoted, and thereby the ftagnation 

X4 of 



320 P R A C T I C E 

of fluids in their extremities prevented* 
Accordingly, the ufe of the flefh brufli 
has often contributed to difcufs cedema- 
tons fwellings. It appears to me that 
friction, for the purpofes now mentioned, 
is more properly employed in the morn- 
ing, when the fwelling is very much gone 
cfF, than in the evening, when any confi- 
derable degree of it has already come on. 
I apprehend alfo, that friction being made 
from below upwards only, is more ufeful, 
than when made alternately upwards and 
downwards. . It has been common, in- 
ftead of employing the flefh brufh, to 
make the friction by warm and dry flan- 
nels ; and this may in fbme cafes be the 
molt convenient : but I cannot perceive 
that the impregnation of thefe flannels 
with certain dry fumes is of any bene- 
fit. 

1 69 1. With refpect to exercife, I muft 

obferve. 



O F P H Y S I C. 321 

obferve, that although perfons being much 
in an erect pofture during the day, may 
feem to increafe the fwelling which comes 
on at night j yet as the action of the muf- 
cles has a great fliare in promoting the 
motion of the venous blood, fo I am cer- 
tain, that as much exercife in walking as 
the patient can eafily bear, will often pre- 
vent that cedeniatous fwelling which much 
ftanding, and even fitting, would have 
brought on. 

1692. Thefe meafures, however, al- 
though they may be ufeful at the coming 
on of a dropfy, whofe caufes are not very 
powerful, will be often inefficient in a 
more violent difeafe ; and fuch therefore 
will require more powerful remedies. 
Thefe are, exercife and tonic medicines ; 
which may be employed both during the 
courfe of the difeafe, and efpecially after 
the water has been evacuated. 

1 693. Exercife 



322 PRACTICE 

1693 Exercife is fuited to amft in eve- 
ry function of the animal oecocomy, par- 
ticularly to promote perfpiration, and 
thereby prevent the accumulation of wa- 
tery fluids in the body. I apprehend alfo, 
that it may be the moft effectual means 
for preventing the fkin from being in an 
imbibing Mate; and, as it has been hinted 
above on the fubject of emaciation (1607), 
I am perfuaded, that a full and large per- 
fpiration will always be a means of excit- 
ing abforption in eyery part of the fyftem. 
Exercife, therefore, promifes to be highly 
ufeful in dropfy ; and any mode of it may 
be employed that the patient can moft 
conveniently admit of. It fhould, how- 
ever, always be as much as he can eafily 
bear; and in anafarca, the fhare which 
the exercife of mufcles has in promoting 
the motion of the venous blood, induces 
me to think that bodily exercife, to what- 
ever 



O F . P H Y S I C. 323 

ever degree the patient can bear it, will 
always be the mod ufeful. From fome 
experience alfo, I am perfuaded, that by 
exercife alone, employed early in the dif- 
eafe, many dropfies may be cured. 

1 694. Befides exercife various tonic re- 
medies are properly employed to reftore 
the tone of the fyftem. The chief of thefe 
are, chalybeates, the Peruvian bark, and 
various bitters. Thefe are not only fuit- 
ed to reftore the tone of the fyftem in 
general, but are particularly ufeful in 
ftrengthening the organs of digeftion, 
which in dropfies are frequently very 
much weakened : and for the fame pur- 
pofe alfo aromatics may be frequently 
joined with the tonics. 

1695., Cold bathing is upon many oc- 

cafions the mod powerful tonic we can 

• employ; but at the beginning of dropfy, 

2 when 



324 PRACTICE 

"when the debility of the fyftem is con- 
siderable, it can hardly be attempted with 
fafety. After, however, the water of 
dropfies has been very fully evacuated,' 
and the indication is to flrengthen the 
fyftem for preventing a relapfe, "cold bath- 
ing may perhaps have a place. It is, at 
the fame time^ to be admitted with cau- 
tion ; and can fcarcely be employed till 
the fyftem has otherwife recovered a 
good deal of vigour. When that in- 
deed has happened, cold bathing may be 
very ufeftfl in confirming and completing 
it. 

1696. In perfons recovering from drop- 
fy, while the Several means now men- 
tioned for Strengthening the fyftem are 
employed, it will be proper at the fame 
time to keep conftantly in view the fup- 
port of the watery excretions^ and con- 
fequently the keeping up the perfpira- 

tion 



O F P H Y S I C. 325 

tion by a great deal of exercife, and con- 
tinuing the full flow of the urinary ex- 
cretions by the frequent ufe of diure- 
tics. 



SECT. 



p$ PRACTICE 



SECT. IT. 



OF THE 



HYDROTHORAX, 



OR 



DROPSY of the BREAST. 



1697. The preternatural collection of 
ferous fluid in the thorax, to which we 
give the appellation of Hydrothorax, oc- 
curs more frequently than has been ima- 
gined. Its prefence, however, is not al- 

wavs 



OF PHYSIC. 327 

ways to be very certainly known; and 
it often takes place to a confiderable der 
gree before it be difcovered. 

1698. Thefe collections of watery fluids 
in the thorax, are found in different fitua- 
tions. Very often the water is found at 
the fame time in both facs of the pleura, 
but frequently in one of them only. 
Sometimes it is found in the pericardium 
alone; but for the moft part it only ap- 
pears there when at the fame time a col- 
lection is prefent in one or both cavities 
of the thorax. In fome inftances, the col- 
lection is found to be only in that cellular 
texture of the lungs which furrounds the 
bronchia^, without there being at the fame 
time any effufion into the cavity of the 
thorax. 

Pretty frequently the water collected 
confiits chiefly of a great number of hy- 

daudes 



328 PRACTICE 

datides in different fituations ; fometimes 
feemingly floating in the cavity, but fre- 
quently connected with and attached to 
particular parts of the internal furface of 
the pleura. 

1699. From the collection of water be- 
ing thus in various fituations and circum- 
ftances, fymptoms arife which are differ- 
ent in different cafes ; and from thence it 
becomes often difficult to afcertain the pre- 
fence and nature of the affection. I fhall 
however, endeavour here to point out the 
mofl common fymptoms, and efpecially 
thofe of that principal and moll frequent 
form of the difeafe, when the ferous fluid 
is prefent in both facs of the pleura, or, 
as we ufually fpeak, m both cavities of the 
thorax. 

1700. The difeafe frequently comes 
on with a fenfc of anxiety about the low- 

3 e* 



OF PHYSIC. 



3 2 9 



er part of the fternum. This, before it 
has fubfifted long, comes to be joined 
with fome difficulty of breathing ; which 
at firft appears only upon the perfon's 
moving a little fafter than ufual, upon his 
Walking Up an acclivity, or upon his as- 
cending a Hair-cafe : but after fome time 
this difficulty of breathing becomes morel 
conftant and confiderable, efpecially dur- 
ing the night, when the body is in a hori- 
zontal fitUation. Commonly, at, the fame 
time, lying upon one fide is more eafy 
than upon the other, or perhaps lying upon 
the back more eafy than upon either fide. 
Thefe circumflances are ufually attended 
with a frequent cough, that is at firft dry j 
Tnit which, after fome time, is accom- 
panied with an expectoration of thin 
mucus. , 

With all thefe fymptoms, the hydro- 
thorax is not certainly difcovered, as the 
Vol. IV* Y fame 



33« PRACTICE 

lame fymptoms often attend other di£ 
eafes of the bread. When, however, a- 
long with thefe fymptoms, there is at 
the fame time an cedematous fwelling of 
the feet and legs, a leucophlegmatic pale- 
nefs of the face, and a fcarcity of urine, 
the exiftence of a hydrothorax can be no 
longer doubtful. Some writers have told 
us, that fometimes in this difeafe, before 
the fwelling of the feet comes on, a wa- 
tery fwelling of the fcrotum appears : but 
I have never met with any inftance of 
this. 

1 70 1. Whilft the prefence of the dif- 
eafe is fomewhat uncertain, there is a fym- 
ptom which fometimes takes place, and 
has been thought to be a certain charadleri- 
ftic of it; and that is, when, foon after 
the patient has fallen afleep, he is fuddenly 
awaked with a fenfe of anxiety and dif- 
ficult breathing, and with a violent palpi- 
tation of the heart. Thefe feelings imme- 
diately 



OF PHYSIC. 331 

diately require an erect - pofture ; and very 
often the difficulty of breathing continues 
to require and to prevent fleep for a great 
part of the night. This fymptom I have 
frequently found attending the difeafe ; 
but I have alfb met with feveral inftances 
in which this fymptom did not appear. I 
mud remark further, that I have not found 
this fymptom attending the empyema, or 
any other difeafe of the thorax ; and there- 
fore, when it attends a difficulty of breath- 
ing, accompanied with any the fmalleft 
fymptom of dropfy, I have had no doubt 
in concluding the prefence of water in the 
cheft, and have always had my judgement 
confirmed by the fymptoms which after- 
wards appeared. 

1702. The hydrothorax often occurs 

with very few, or almoft none, of the 

fymptoms above mentioned; and is not, 

therefore, very certainly difcovered till 

Y 2 fome 



$p PRACTICE 

fome others appear. The moft decifive 
fymptom is a fluctuation of water in the 
cheft, perceived by the patient himfelf, or 
by the phyfician, upon Certain motions 
of the body. How far the method pro- 
pofed by Auenbrugger will apply to 
afcertain the prefence of water and the 
quantity of it in the cheft, I have not 
had oceafion or opportunity to obferve. 

It has been faid, that in this difeafe 
fome tumour appears upon the fides or 
upon the back ; but I have not met with 
any inftance of 'this. In one inftance of 
the difeafe, I found one fide of the thorax . 
confiderably enlarged, the ribs ftanding 
out farther on that fide, than upon the 
other. 

A numbnefs and a degree of palfy in 
one or both arms, has been frequently 
©bferved to attend a hydrothorax. 

Soon 



O F P H Y S I C. 333 

Soon after this difeafe has made 
.fome progrefs, the pulfe commonly be- 
comes irregular, and frequently inter- 
mitting: but this happens in fo many 
other difeafes of the breaft, that, unlefs 
when it is attended with fome other of 
the above-mentioned fymptoms, it can- 
not be considered as denoting the hydro- 
thorax. 

1703. This difeafe, as other dropfies, is 
commonly attended with thirft and a 
fcareity of urine, to be explained in the 
fame manner as in the cafe of anafarca 
(1673.) The hydrothorax, however, is 
fometimes without thirft, or any other 
febrile fymptom ; although I believe this 
happens in the cafe of partial affections 
only, or when a more general affeclion 
is yet but in a flight degree. In both 
cafes, however, and more efpecially when 
the difeafe is confiderably advanced, fome 
Y 3 degree 



334 PRACTICE 

degree of fever is generally prefent : and 
I apprehend it to be in fuch Cafe, that 
the perfons affected are more than ufually 
fenfible to cold, and complain of the cold- 
nefs of the air when that is not perceived 
by other perfons. 

1704. The hydrothorax fometimes ap- 
pears alone, 'without any other fpecies of 
dropfy being prefent at the fame time : 
and in this cafe the difeafe, for the mod 
part, is a partial affection, as being 
either of one fide of the thorax only, or 
being a collection of hydatides in one 
part of the cheft. The hydrothorax, how- 
ever, is very often a part of more uni- 
verfal dropfy, and when at the fame 
time there is water in all the three prin- 
cipal cavities, and in the cellular texture 
of a great part of the body. I have met 
with feveral inflances in which fuch uni- 
verfal dropfy began firft by an effufion 

into 



O F P H Y S I C. 335 

into the thorax. The hydrothorax, how- 
ever, more frequently comes on from an 
anafarca gradually increamig ; and, as I 
have faid above, the general diatheiis 
feems often to affect the thorax fooner 
than it does either the head or the 
abdomen. 

1705. This difeafe feldom admits of a 
cure, or even of alleviation, from re- 
medies. It commonly proceeds to give 
more and more difficulty of breathing, 
till the action of the lungs be intirely in- 
terrupted by the quantity of water effuf- 
ed ; and the fatal event frequently hap- 
pens more fuddenly than was expected. 
In many of the inftances of a fatal 
hydrothorax, I have remarked a fpitting 
of blood to come on feveral days before 
the patient died. 

Y 4 1706. The 



$$6 PRACTICE 

1706. The caufe of hydrothorax is 
often manifeftly one or other of the ge- 
neral caufes of dropfy pointed out above : 
but what it is that determines thefe ge- 
neral caufes to act more efpecially in the 
thorax, and. particularly what it is that* 
produces the partial collections that oc- 
cur there, I do not find to be eanly afcer- 
tained. 

1707. From what has been faid above it 
will be evident, that the cure of hydro- 
thorax muft be very much the fame with 
that of anafarca ; and when the former 
is joined with the latter as an effect of 
the fame general diathefis, there can be 
no doubt of the method of cure being 
the fame in both. Even when the hydro- 
thorax is alone, and the difeafe partial, 
from particular caufes acting in the 
thorax only, there can hardly be any 
other meafures employed, than the ge- 
neral 



OF PHYSIC. 337 

neral ones propofed above. There is only- 
one particular meafure adapted to the 
hydrothorax ; and that is, the drawing 
ofF the accumulated waters by a para- 
centefis of the thorax. 

170&. To what cafes this operation 
may be mod properly adapted, I find it 
difficult to determine. That it may tje 
executed with fafety, there is no doubt ; 
and that it has been fometimes praclifed 
with fuccefs, feems to ,be very well 
vouched *. When the difeafe depends 

upon 

* In the memoirs of the Academy of Sciences at Paris, 
for 1703, M. Du Verney relates the cafe of a woman 
who had both an Afcites and Hydrothorax. He jirfl 
emptied the abdomen by tapping, and a few days after- 
wards he pierced the thorax .with a trochar, near to the 
fpine, between the fecond and third falfe ribs ; by which 
opening he drew off a confiderable quantity of water : 
the operation gave immediate relief to the patient, and 

me 



333 PRACTICE 

upon a general hydropic diathefis, it caa- 
jiot alone prove a cure, but may give 

fne was able to return to her ordinary employments ia 
about a month's time. 

Bianchi alfo relates a fuccefsful operation of tapping 
the thorax ; but he feems to be timid in his practice, 
and confefles that he has feldom ventured on the opera- 
tion. 

The practice of evacu'ating water contained in the 
thorax by an incifion is very old. We find it recom- 
mended by Hippocrates, with particular directions for 
performing the operation, in his fecond book on difeafes. 
See the Geneva edition ,of Foefius's Hippocrates, 
P a g- 463. 

That the practice was frequently attended with fuc- 
cefs, in thofe early ages, is fufficiently evident by the 
context ; for Hippocrates, after describing the operation, 
and the fubfequent management of the patient, fays, 
*' If pus appear on. the plailer covering the wound on 
" the fifth day after the operation, the patient generally 
" recovers ; if not, he is feized with a cough and thirft, 
" and dies." 



O F P H Y S I C. 339 

a temporary relief; and when other 
remedies feem to be employed with ad- 
vantage, the drawing off the water may 
very much favour a complete cure. I 
have not, however, been fo fortunate as 
to fee it praclifed with any fuccefs ; and 
even where it was moft promifing, that 
is, in cafes of partial affection, my ex- 
pectations have been difappointed from it. 



SECT. 



34° PRACTICE 



SECT. III. 



OF 



ASCITES, or DROPSY 



OF THE 



LOWER BELLY, 



1 709. , The name of AJcites is given to 
every collection of waters cauling a gene- 
ral fwelling, and diftenfion' of the lower 
belly j and fuch collections are more fre- 
quent 



OF PHYSIC. 341 

quent than thofe which happen in the 
thorax. 

17 10. The collections in the lower bel- 
ly, like thofe of the thorax, are found in ' 
different fituations. Mod commonly they 
are in the fac of the peritonaeum, or gene- 
ral cavity of the abdomen : but they often 
begin by facs formed upon, and connected 
with, one or other of the vifcera ; and per- 
haps the mod frequent inftances of this 
kind occur in the ovaria of females. Some- 
times the water of afcites is found entirely 
without the peritonaeum, and between this 
and the abdominal mufcles. 

1 7 1 1 . Thefe collections connected with 
particular vifcera, and thofe formed with- 
out the peritonseum, form that difeafe 
which authors, have termed the encyfied 
dropfy, or hydrops faccatus. Their precife 
feat, and even their exiftence, is very often 

3 difficult 



342 PRACTICE 

difficult to be afcertained. They are 
generally formed by collections of hyda- 
tides. 

17 1 2. In the moft ordinary cafe, that of 
abdominal dropfy, the fwelling at firft is 
in fome meafure over the whole belly, but 
generally appears moft confiderable in the 
epigaftrium. As the difeafe,' however, ad- 
vances, the fwelling becomes more uni- 
form over the whole. The diftenfion and 
fenfe of weight, though confiderable, vary 
a little according as the pofture of the 
body is changed ; the weight being felt 
the moft upon the fide on which the pa- 
tient lies, while at the fame time on the 
oppofite fide the diftenfion becomes fome- 
what lefs. In almoft all the inftances of 
afcites, the fluctuation of the water within, 
may be perceived by the practitioner's 
feeling, and fometimes by his hearing. 
This perception of fluctuation does not 

certainly 



O F P H Y S I C. 343 

certainly diftingufh the different dates of 
dropfy ; but ferves very well to diftinguifh 
dropfy from tympanites, from cafes of 
phyfconia, and from the ftate of pregnancy^ 
in women. 

1 7 13. An afcites frequently occurs 
when no other fpecies of dropfy does at 
the fame time appear ; but fometimes 
the afcites is a part only of univerfal 
dropfy. In this cafe, it ufually comes 
on in confequence of an anafarca, gradu- 
ally increafing ; but its being joined with 
anafarca, does not always denote any 
general diathefis, as for the moil part an 
afcites fooner or latter occafions cedematous 
fwellings of the lower extremities. When 
the collection of water in the abdomen, 
from whatever caufe, becomes confider- 
able, it is always attended with a difficulty 
of breathing : but this fymptom occurs 
often when, at the fame time,- there is 

no 



344 PRACTICE 

fro water in the thorax. The afcites is 
fometimes unaccompanied with any 
fever 5 but frequently there is more or 
lefs of fever prefent with it. The difeafe 
is never confiderable without being at- 
tended with thirft and a fcarcity of 
urine. 

1 7 14. In the diagnofis of afcites, the 
greateft difficulty that occurs, is in dif- 
cerning when the water is in the cavity 
of the abdomen, or when it is in the dif- 
ferent dates of encyfled dropfy above 
mentioned. There is, perhaps, no certain 
means of afcertaining this in all cafes; 
but in many we may attempt to form 
fome judgement with regard to it* 

"When the antecedent circiimftances 
give fufpicion of a general hydropic dia- 
thefis ; when at the fame time fome de- 
gree of dropfy appears in other parts of 

ths" 



OF PHYSIC. 345 

the body ; and, when, from its firft ap-* 
pearance, the fwelling has been equally 
over the whole belly, we may generally 
prefume that the water is in the cavity 
of the abdomen. But when an afcites has 
not been preceded by any remarkable 
cachectic ftate of the s fyftem, and when 
at its beginning the tumour and tenfion 
had appeared in one part of the belly 
more than another, there is reafon to 
fufpect an encyfted dropfy. Even when 
the tenfion and tumour of the belly have 
become general and uniform over the 
whole ; yet if the fyftem of the body in 
general appear to be little affecled ; if the 
patient's ftrength be little impaired ; if the 
appetite continue pretty entire, and the 
natural fleep be little interrupted ; if the 
menfes in females continue to flow as ufual ; 
if there be yet no anafarca ; or, though 
it may have already taken place, if it 
be dill confined to the lower extremities, 
and there be no leucophlegmatic palenefs 
Vol. IV. Z or 



346 PRACTICE 

or fallow colour in the countenance ; if 
there be no fever, nor fo much thirft, 
or fcarcity of urine, as occur in a more 
general affection ; i then, according as 
more of thefe different circumftances take 
place, there will be the ftronger ground 
for fuppofing the afcites to be of the 
encyfled kind. 

The chief exception to be made from 
this as a general rule, will, in my opinion, 
be when the afcites may, with much 
probability, be prefumed to have come 
on in confequence of a fcirrhous liver j 
which, I apprehend, may occafion a col- 
lection of water in the cavity of the 
abdomen, while the general fyftem of the 
body may not be otherwife much af- 
fe&ed. 

1 715. With refpect to the cure of 
2 afcites 



OF PHYSIC. 347 

afcites when of the encyfted kind it does 
not, fo far as I know, admit of any. 
When the collection of water is in the 
abdominal cavity alone, without any 
other fpecies of dropfy prefent at- the 
fame time, I apprehend the afcites will 
always be of* difficult cure ; for it may 
be prefumed to depend upon a fcirrhofity 
of the liver, or other confiderable af- 
fection of the abdominal vifcera, which 
I conceive to be of very difficult cure, 
and therefore the afcites depending upon 
them. At the fame time, fuch cafes may 
often admit of a temporary relief by the 
paracentefis. 

1 716. When the afcites is a part of uni- 
verfal dropfy, it may, as far as other cafes 
of that kind can, admit of cure ; and it 
will be obvious, that fuch a cure mufl 
be obtained by the fame means as above 
Z 2 propofed 



348 PRACTICE 

propofed for the cure of general ana- 
iarca 



It frequently happens, that the afcites 
is attended with a diarrhoea ; and, in 
that cafe, does not admit of the ufe of 
purgatives fo freely as cafes of anafarca 
commonly do. It is therefore often to 
be treated by diuretics almoft alone. 

The diuretics that may be employed, 
are chiefly thofe above mentioned ; but in 
afcites, a peculiar one has been found out. 
It is a long continued gentle friifUon of 
the fkin over the whole of the abdomen, 
by the fingers dipped in oil. This has 
fometimes been ufeful in exciting an in- 
creafed flow of urine ; but in molt of the 
trials of it which I have known made it 
has failed in producing that effect. 

1 71 7. The 

* See the notes on Article, 1683. 



O F P H Y S I C. 349 

1 71 7. The afcites admits of a particular 
means for immediately drawing off the 
collected waters; and that is the well- 
known operation of the paracentesis of the 
abdomen. In what circumftances of as- 
cites this operation can mod properly be 
propofed, it is difficult to determine j but, 
fo far as I can judge, it muft be regulated 
by very much the fame considerations as 
thofe above mentioned with regard to the 
paracentesis of the thorax. 

The manner of performing the paracen- 
tesis of the abdomen, and the precautions , 
to be taken with refpect to it, are now fo 
commonly known, and delivered in fo 
many books, that it is altogether unnecek 
fary for me to offer any directions upon 
that subject here ; efpecially after the full 
and judicious information and directions 
given by Mr Bell, in the fecond volume 
gf his Svftem of Surgery, 

Z. 3 CHAP. 



J50 PRAC T ICE 



CHAP. IV. 



OF 

GENERAL SWELLINGS, 

ARISING FROM 

/ 

An increased Bulk of the whole 
Substance of particular parts. 



1 718. T TPON the fubje&s of this 

^~* chapter, feveral nqfological 

difficulties occur, and particularly with 

refpecl to admitting the Thyfconia into 

the 



' OF PHYSIC. 3Si 

the order of General Swellings. At 
prefent, however, it is not neceffary for 
me to difcufs this point, as I am here to 
omit entirely the consideration of Phy- 
fconia ; both becaufe it can feldom admit 
of any fuccefsful practice, and becaufe 
I cannot deliver any thing ufeful either 
with regard to the pathology or practice 
in fuch a difeafe. 

17 19. The only other genus of difeafe 
comprehended under the title of the 
prefent chapter, is the Rachitis ; and this 
being both a proper example of the clafs 
of Cachexy, and of the order of Iniume- 
fcent'w or General fwellings, I fhall offer 
fome obfervations with regard to it. 

OF RACHITIS, or RICKETS. 

1720. This difeafe has been fuppofed 

to have ' appeared only in modern times, 

Z 4 and 



352 PRACTICE 

and not above two hundred years ago. 
This opinion, notwithftanding it has been 
maintained by perfons of the moft re- 
fpeclable authority*, appears to me, from 
many confiderations, improbable ; but 
it is a point of too little confequence to 
detain my readers here. The only ap- 
plication of it which deferves any notice 
is, that it has led to a notion of the difeafe 
having arifen from the lues venerea, 
which had certainly made its firft ap- 
pearance in Europe not very long before 
the date commonly affigned for the ap- 
pearance of rachitis j but I fhall heareafter 
Jhow, that the fuppofed connection be- 
tween the Siphylis and Rachitis is with- 
out foundation f. 

1 72 1. In 

* Boerhaave was of this opinion, fee Van Swieten'a 
Commentary on Aphorifm 1482. 

f See Article, 1727. 



OF PHYSIC. 353 

1721. In delivering the hiftory of the 
Rickets, I muft, in the firft place, obferve,' 
that with refpect to the antecedents of 
the difeafe, every thing to be found in 
authors upon this fubject, appears to 
me to reft upon a very uncertain found- 
ation. In particular, with refpect to the 
ftate of the parents whofe offspring be- 
come affected with this difeafe, 1 have 
met with many inftances of.it in children 
from feemingly healthy parents ; and 
have met likewife with many inftances 
of children who never became affected 
with it, although born of parents who, 
according to the common accounts, mould 
have produced a rickety offspring ; fo 
that, even making allowance for the un- 
certainty of fathers, I do not find the 
general opinion of authors upon this fub- 
ject to be properly fupported. 

2 1722. The 



354 -P R A CTICE 

1722. The difeafe, however, may be 
juftly confidered as proceeding from 
parents ; for it often appears in a great 
number of the fame family : and my 
obfervation leads me to judge, that it 
originates more frequently from mothers 
than from fathers. So far as I can refer 
the difeafe of the children to the ftate of 
the parents, it has appeared to me _moft 
commonly toarife from fome weaknefs, 
and pretty frequently from a fcrophulous 
habit, in' the mother. To conclude the 
fubjecl, I mult remark, that in many 
cafes I have not been able to difcern the 
condition of the parents, to which I could 
refer it. 

When nurfes, other than the mothers, 

- have been employed to fuckle children, 

it has been fuppofed that fuch nurfes 

iiave frequently given occafion to the 

difeafe : 



OF PHYSIC. 35S 

difeafe * : unci when nurfes have both pro- 
duced and have fuckled children who' 
became rickety, there may be ground 
to fufpect their having occafioned the 
difeafe in the children of other perfons : 
but I have had few opportunities of 
afcertaining this matter. It has in fome 
meafure appeared to me that thofe nurfes 
are mod likely to produce this difeafe, 
who give infants a large quantity of 
very watery milk, and who continue to 
fuckle them longer than the ufual time. 
Upon the whole, however, I am of opi- 
nion, that hired nurfes feldom occafion 
this difeafe, unlefs when a predifpolition 
to it has proceeded from the parents. " 

1723. With 



* This opinion was held by Boerhaave, and notwith- 
standing what the Author fays at the end of this para- 
graph, the opinion is certainly founded on experience. 



35$ PRACTICE 

1723. With regard to the other ante* 
cedents, which have been ufualiy enu- 
merated by authors as the remote caufes 
of this difeafe, I judge the accounts given 
to be extremely fallacious ; and I am 
very much perfuaded, that the circum- 
ftances in the rearing of children, have 
lefs efTea in producing rickets than has 
been imagined. It is indeed not unlikely, 
that fome of thefe circumftances men- 
tioned as remote caufes may favour, 
while other circumftances may refill, the 
coming on of the difeafe ; but at the fame 
time, I doubt, if any of the former, would 
produce it where there was no predif- 
pofuion in the child's ' original conftitu- 
tion. This opinion of the remote caufes, 
I have formed from obferving, that the 
difeafe comes on when none of thefe had 
been applied ; and more frequently that 
many of them had been applied without 

occafioning 



O F P H Y S I C. . 3S7 

occafioning the difeafe. Thus the learned 
Zeviani alleges, that the difeafe is pro- , 
duced by an acid from the milk with 
which a child is fed for the fTrft nine 
months of its life : but almoft all children 
are fed with the fame food, and in which 
alfo an acid is always produced ; while at 
the fame time, not one in a thoufand of 
the infants fo fed becomes affected with 
the rickets. If, therefore, in the infants 
who become affected with this difeafe, 
a peculiarly noxious acid is produced, we 
muft feek for fome peculiar caufe of its 
production, either in the quality of the 
milk, or in the conftitution of the child ; 
neither of which, however, Mr Zeviani 
has explained. I cannot indeed believe 
that the ordinary acid of milk has any 
ihare in producing this difeafe, becaufe 
I have known many inftances of the acid 
being produced and occafioning various 

diforders, 






353 PRACTICE 

diforders, without however, its ever pro- 
ducing rickets* 



Another of the remote caufes com- 
monly affigned, is the child's being fed 
. with unfermented farinaceous food. But 
over the whole world children are fed 
with fuch farinacea, while the difeafe of 
rickets is a rare occurrence : and I have 
known many inftances where children 
have been fed with a greater than ufual 
proportion of fermented farinacea, and 
aifo a greater proportion cf animal food, 
without thefe preventing the difeafe. In 
my apprehenfion, the like obfervations 
might be made with refpecl to mod of 
the circumflances that have been men- 
tioned as the remote caufes, of rickets. 

1 724. Having thus offered my opinion 
concerning the fuppofed antecedents of 
this difeafe, I proceed now to mention 

the 



OF PHYSIC- 359 

the phenomena occuring after it has 
actually come on. 

The difeafe feldom appears before the 
ninth month, and feldom begins after the 
fecond year, of a child's age *. In the in- 
terval between thefe periods, the appear- 
ance of the difeafe is fometimes fooner, 
fometimes later ; and commonly at firft 
the difeafe comes on flowly. The firft ap- 
pearances are, a flaccidity of the flefh, the 
body at the fame time becoming leaner, 
though food be taken in pretty largely. 
The head appears large with refpect to the 
body ; with the fontanelle, and perhaps 
the futures, more open than ufual in chil- 
dren of the fame age. The head continues 
to grow larger ; in particular, the fore- 
head becoming unufually prominent ; and 

at 

* This admirable defcription of the difeafe merits the 
peculiar attention of the young praftitioner. 






360 PRACTICE 

at the fame time the neck continues {len- 
der, or feems to be more fo, in proportion 
to the head. The dentition is flpw, or 
much later than ufual ; and thofe teeth 
which come out, readily become black 
and frequently again fall out. The ribs 
lofe their convexity* and become flattened 
on the fides ; while the fternum is pufhed 
outward, and forms a fort of ridge. At 
the fame time, or perhaps fooner, the 
epiphyfes at the fevqral joints of the 
limbs become fwelle.d ; while the limbs 
between the joints appear, or perhaps ac- 
tually become more {lender* The bones 
feem to be every where flexible, becoming 
variously diftorted ; and particularly the 
fpine of the back becoming incurvated in 
different par ts of its length. If the child, 
at the time the difeafe comes on, had ac- 
quired the power of walking, it becomes 
daily more feeble in its motions, and more 
averfe to the exertion 'of them, lofing at 

length 



O F P H Y S I C. 361 

length the power of walking altogether. 
Whilft thefe fymptoms go on increafing, 
the abdomen is always full, and preterna- 
turally tumid. The appetite is often good, 
but the ftools are generally frequent and 
loofe. Sometimes the faculties of the 
mind are impaired, and ftupidity or fatuity 
prevails ; but commonly a premature 
fenfibility appears, and they acquire the 
faculty of fpeech fooner than ufual. At 
the firft coming on of the difeafe, there 
is generally no fever attending it : but it 
feldqm continues long, till a frequent 
pulfe, and other febrile fymptoms, come 
to be conftantly prefent. With thefe 
fymptoms the difeafe proceeds, and con- 
tinues in fome inftances for fome years ; 
but very often, in the courfe of that time, 
the difeafe ceafes to advance ; and the 
health is entirely eftablifhed, except that 
the diftorted limbs, produced during the 
difeafe, continue for the reft of life. In 
Vol. IV. A a oth^ 



o 



62 PRACTICE 



other cafes, however, the difeafe proceeds 
increafing, till it has affected almoft every 
function of the animal ceconomy, and at 
length terminates in death. The variety 
of fymptoms which in fuch cafes appear, 
it does not feem neceffary to enumerate, 
as they are not eflfential to the conftitution 
of the difeafe, but are merely confequences 
of the more violent conditions of it. In 
the bodies of thofe who have died, various 
morbid affections have been difcovered 
in the internal parts, Moft of the vifcera 
of the abdomen have been found to be 
preternaturally enlarged. The lungs have 
alfo been found in a morbid ftate, feem- 
ihgly from fome inflammation that had 
come on towards the end of the difeafe. 
The brain has been commonly found in a 
flaccid ftate, with effufions of a ferous 
fluid into its cavities. Very univerfally 
the bones have been found very foft, and 
fo much foftened as tP be readily cut by ^ 

knife 



OF PHYSIC. 363 

knife. The ihids have been always found 
in a diflblved (late, and the mufcular parts 
very foft and tender ; and the whole of the 
dead body without any degree of that rigidi- 
ty which is fo common in almoft all others. 

1725. From thefe circumftances of the 
difeafe, it feems to confift in a deficiency 
of that matter which mould form the 
folid parts of the body. This efpecially 
appears in the faulty ftate of ofiification, 
feemingly depending upon the deficiency 
of that matter which mould be depofited 
in the membranes which are deftined to 
become bony, and fhould give them their 
bony hardnefs. It appears that this mat- 
ter is not fupplied in due quantity ; but, 
that, in place of it, a matter fitted to increafe 
their bulk particularly in the epiphyfes, is 
applied too largely. What this deficiency of 
matter depends upon, is difficult to be afcer- 
tained. It may be a fault in the organs of 
A a 2 digeftion 



364 PRACTICE 

digeftion and aflimilation, which prevents 
the fluids in general from being properly- 
prepared ; or it may be a fault in the 
organs of nutrition, which prevents the 
fecretion of a proper matter to be applied. 
With refpedt to the latter, in what it may 
confift, I am entirely ignorant, and can- 
not even difcern that fuch a condition 
exifts: but the former caufe, both in 
its nature and exiflence, is more readily 
perceived ; and it is probable that it has 
a considerable influence in the matter ; as 
in rachitic perfons a thinner ftate of the 
blood both during life and after death, fo 
commonly appears. It is this ftate of the 
fluids, or a deficiency of bony matter in 
them, that I confider as the proximate 
caufe of the difeafe : and which again 
may in fome meafure depend upon a 
general laxity and debility of the moving 
fibres of the organs that perform the func- 
tions of digeftion and aflimilation. 

% 1 7 2d. There 



Of P Ht Y S I C 3% 

1716. There is, however, fomething 
{till wanting to explain, why thefe circum- 
ftances difcover themfelves at a particular 
time of life, and hardly ever either before 
or after a certain period ; and as to this 
I would offer the following conjectures. 
Nature having intended that human life 
fhould proceed in a certain manner, and 
that certain functions mould be exercifed 
at a certain period of life only ; fo it has 
generally provided, that at that period, 
and not fooner, the body fhould be fitted 
for the exercife of the functions fuited to 
it. To apply this to our prefent fubject, 
Nature feems to have intended that chil- 
dren fhould walk only at twelve months 
old ; and accordingly has provided, that 
againft that age, and no fooner, a matter 
fhould be prepared fit to give that firm- 
nefs to the bones which is neceffary to 
prevent their bending too eafily under the 
weight of the body. Nature, however, is 
A a 3 not 



366 PRACTICE 

not always fteady and exact in executing 
her own purpofes ; and if therefore the 
preparation of bony matter mall not have 
been made againft the time there is parti- 
cular occafi6n for it, the difeafe of rickets, 
that is, of foft and flexible bones, mud 
come on ; and will difcover itfelf about 
the particular period we have mentioned. 
Further, it will be equally probable, that 
if at the period mentioned the bones mail 
have acquired their due firmnefs, and that 
nature goes on in preparing and fupplying 
the proper bony matter, it may be pre- 
fumed, that againft the time a child is 
two years old, fuch a quantity of bony 
matter will be applied as to prevent the 
bones from becoming again foft and flexible 
during the reft of life j unlefs it happen, 
as indeed it fometimes does, that certain 
caufes occur to wafh out again the bony 
matter from the membranes in which it 
had been depbfited. The account I have 

now 



O F P H Y S I C. 3*7 

now given of the period at which the 
rickets occur, feems to confirm the opi- 
nion of its proximate caufe being a defi- 
ciency of bony matter in the fluids of the 
body. 

1727. It has been frequently fuppofed, 
that a fiphylitic taint has a (hare in produ- 
cing rickets ; but fuch a fuppofition is al- 
together improbable. If our opinion of 
the rickets having exifted in Europe be- 
fore the fiphylis was brought into it, be 
well founded, it will then be certain that 
the difeafe may be occafioned without any 
fiphylitic acrimony having a fhare in its 
production. But further, when a fiphyli- 
tic acrimony is tranfmitted from the pa- 
rent to the offspring, the fymptoms do not 
appear at a particular time of life only, 
and commonly more early than the period 
of rickets : the fymptoms alfo are very 
different from thofe of rickets, and unac- 
A a 4 companied 



368 PRACTICE 

companied with any appearance of the 
latter : and, laftly, the fymptoms of fiphylis 
are cured by means which; in the cafe of 
rickets, have either no effect, or a bad one. 
It may indeed poffibly happen, that fiphylis 
and rickets may appear in the fame per- 
fon ; but it is to be conlidered as an acci- 
dental complication : and the very few 
instances of it that have occurred, are by 
no means fufficient to eflablifh any ne<- 
ceflary connection between the two dif- 
eafes. 

1728. With refpecl to the deficiency of 
bony matter, which I confider as the 
proximate caufe of rickets, fonie further 
conjectures might be offered concerning 
its remote caufes j but none of them ap- 
pear to me very fatisfying j and whatever 
they might be, it appeals to me they 
muft again be refolved into the fuppofi- 

tion 



Of PHYSIC. 3 6 9 

tion of a general laxity and debility of the 
fyftem. 

1729. It is upon this fuppofition almoft 
alone that the cure of rickets has entirely 
proceeded. The remedies have been fuch 
efpecially as were fuited to improve the 
tone of the fyftem in general or of the 
ftomach in particular : and we know that 
the latter are not only fuited to improve 
the tone of the ftomach itfelf, but by that 
means to improve alfo the tone of the 
whole fyftem. 

1730. Of tonic remedies one of the 
mod promifing feems to have been cold 
bathing ; and I have found it the mod 
powerful in preventing the difeafe. For 
a long time part, it has been the practice in 
this country, with people of all ranks, 
to wafh their chifdren from the time of 
their birth with cold water ; and from the 

time 



276 PRACTICE 

time that children are a month old, it has 
been the practice with people of better 
rank to have them dipped entirely in 
cold water every morning : and wherever 
this practice has been purfued, I ha-ve not 
met with any inftance of rickets, Amongft 
our common people, although they wafh 
their children with cold water only, yet 
they do not fo commonly praclife im*- 
merfion : and when amongft thefe I meet 
with inftances of rickets, I prefcribe cold 
bathing j which accbrdingly has often 
checked the progrefs of the difeafe, and 
fometimes feems to have cured it en- 
tirely. 

1 73 1. The remedy of* tins Veneris ^re- 
commended by Mr Boyle, and fince his 
time very univerfally employed, is to be 
confidered as entirely a tonic remedy. 
That or fame other preparation of iron I 
have almoft ccnflantly employed, though 

not 



OF PHYSIC. 371 

not indeed always with fuccefs. I have 
been perfuaded, that the ens veneris of 
Mr Boyle, notwithstanding his giving 
it this appellation, was truly a prepara- 
tion of iron, and no other than what we 
now name the Flares Martiaks * : but it 
appears, that both Benevoli and Buchner 
have employed a preparation of copper ; 
and I am ready to believe it to be a more 

powerful 

* The dofe of this medicine is from four to twenty 
grains, it muft be given in the form of a bolus. The 
young practitioner ought to beware of prefcribing Flores 
martiales in pills, which will fwell and crumble to 
pieces if they are not compofed of a confiderable 
quantity of fome gummi refin. 

The Flores martiales, may be very conveniently 
given in a tincture of proof fpirit. There is a for- 
mula of it in the laft London pharmacopoeia, under 
the name of Tinftura ferri Ammoniacalis. The dofe 
of it is a tea fpoonful in a wine glafs of cold water, 
and it is a very elegant form of adminiflering thaly- 
beates. 



372 PRACTICE 

powerful tonic than the preparations of 



iron 



* 



1732. Upon the fuppofition of tonic 
Remedies being proper in this difeafe, I 
have endeavoured to employ the Peruvian 
bark : but from the difficulty of admi- 
niftering it to infants in any ufeful 
quantity, I have not been able to difcover 
its efficacy ; but I am very ready to be- 
lieve the teftimony of De Haen upon this 
fubjedl f. 

1733. Exercife,- 

* Copper is a very dangerous remedy, as was men- 
tioned above in the notes on article 1336. The Author 
had a very high opinion of copper as a tonic. 

f It is deubtlefs difficult to make children fwallow 
a fufficient quaritity of bark to produce any good effects, 
jet it is not impoffible. The formula beft adapted for 
children, is the powder of the extract; but as it fome 

times 



QF PHYSIC. 37 3 

1722. Exercife, which is one of the 
mod powerful tonics, has been properly- 
recommended for the cure of rickets ; 
and as the exercife of geftation only can 
be employed, it fhould always be, with 
the child laid in a horizontal fituation ; 
as the carrying them or moving them in 
any degree of an erect pofture, is very 
apt to occaficn fbme diflortion. It is ex- 
tremely probable, that, in this difeafe, 
friction with dry flannels may be found 
an ufeful remedy. 

1734. It 

times occafio;is cotiftipation, this effect mull be guarded 
againft by fome proper laxative, efpecially by Rhubarb 
given either with the bark or feparately. The following 
formula is a proper dofe for a child of two years old, 
to be repeated twice a day ; 

R. Extr. Cort. Peruv. dur. gr. viii. 
Pulv. Rad. Rhej. gr. x. 
Sacth Alb. gr. xv. 
^1. f. pulv. 



374 PRACTICE 

1734. It is alfo fuffieiently probable, 
that the avoiding of moifture is not only 
advifable, but may likewife'* be of fervice 
in the cure of this difeafe. 



There is no doubt that a certain diet 
may contribute to the fame end ; but 
what may be the mod eligible, I dare 
not determine. I have no doubt that 
leavened bread may be more proper than 
unfermentcd farinacea ; but I cannos 
find any reafon to believe that ftrong 
beer can ever be a proper remedy. 

Practitioners have been divided in opi- 
nion concerning the ufe of milk in this 
difeafe. jfeviani, perhaps from theory, 
condemns the ufe of it : but Benevoli 
employed it without its impeding the cure 
of the difeafe. This laft I have often re- 
marked in the courie of my own practice: 
As it is difficult to fsed children- entirely 

without 



OF PHYSIC. 375 

without milk ; Co I have commonly ad- 
mitted it as a part of the diet of rickety 
children ; and in many inftances 1 can 
affirm, that it did not prevent the cure of 
the difeafe. In cafes, however, of any ap- 
pearance of rickets, and particularly of a 
flow dentition, I have diffuaded the con- 
tinuance of a child upon the breaft ; be- 
caufe the milk of women is a more watery 
nourifhment than that of cows : and I 
have efpecially diffuaded the continuing 
a child upon the breaft, when I thought 
the nurfe gave rather too much of fuch a 
watery nourifhment ; for, as has been 
above mentioned, I have had frequent 
occafion to fufpect, that the milk of fuch 
nurfes has a tendency to favour the com- 
ing on of the rickets *. 

1735- Be- 

* How does this accord with the Jaft fenteace o£ 
Article 1722 ? 



376 PRACTICE 

1735 Befides the remedies and regirnea 
now mentioned, practitioners have com- 
monly employed in this difeafe, both 
emetics and purgatives. When the ap^ 
petite and digeftion are considerably im- 
paired, voniiting, if neither violent nor 
frequently repeated, feems to be of fervice ; 
and, by a moderate agitation of the ab- 
dominal vifcera, may in fome pieafure 
obviate the Stagnation and confequent 
Swelling that ufually occur in them. 

As the tumid State of the abdomen, it> 
constantly to be met with in this difeafe, 
feems to depend very much upon a tym- 
panitic affection of the inteitines ; fo, both 
by obviating this, and by deriving from 
the abdominal vifcera, frequent gentle 
purgatives may be of fervice. Zeviani, 
perhaps properly recommends in particu- 
lar rh\i barb j which, beSides its purgative 

quality, 



O F P H Y S I C. 377 

quality, has thofe alfo of bitter and aftrin- 
gent. 

1736. I have now mentioned moft of 
the remedies commonly employed by the 
practitioners of former times ; but I 
muft not omit mentioning fbme others 
that have been lately fuggefted. The late 
Mr De Haen recommends the teftacea ; 
and aflures us of their having been em- 
ployed with fuccefs ; but in the few trials 
which I have had occafion to make, their 
good effects did not appear. 

The late Baron Van Swieten gives us 
one inftance of rickets cured by the ufe 
of hemlock ; but I do not know that the 
practice has been repeated. 



Vol. IV. B b BOOK 



BOOK III, 



OF THE 



IMPETIGINES, 



OR 



DEPRAVED HABIT, with AFFEC- 
TIONS of the SKIN. 



l 737- ¥ Find it difficult to give any fuf- 
■■ ficiently correct and proper cha- 
racter of this order. The difeafes compre- 
hended 



F ^ p f s i c. 379 

Hended under ;c » depend, for the ii^ part> 
upon a d«' fave ^ ^ ate °^ £ ^ e wao ^ e °f tilc - 
fluids producing tumors^ eruptions, or 
Qt ur preternatural affections of the ikin. 
Although it be extremely difficult to find a 
general character of the order that will ap- 
ply to each of the genera and fpecies, I 
fhall here treat of the principal genera 
which have been commonly comprehend- 
ed under this order, and which I have 
enumerated in my Nofology. 



B b 2 CHAP. 



3&o PRACTICE 



CHAP. I. 



OF 



SCROPHULA, 



OR THE 



KING'S EVIL. 



1 73$- TTHE chara&er of this difeafe 
•*- I have attempted in myNofo- 
logy : but it will be more properly taken 
from the whole of its hiftory, now to be 
delivered. 



'739- It 



OF PHYSIC. '381 

1739. It is commonly, and very ge- 
nerally, a hereditary difeafe ; and although 
it fometimes may, yet it rarely appears, 
but in children whofe parents had at 
fome period of their lives been affected 
with it. Whether it may not fail to ap- 
pear in the children of fcrophulous pa- 
rents, and difcover itfelf afterwards in 
their offspring in' the fucceeding genera- 
tion, I cannot certainly determine ; but 
believe that this has frequently happened. 
It appears to me to be derived more com- 
monly from fathers than from mothers ; 
but whether this happens from there 
being more fcrophulous men than fcro*- 
phulous women married, I am not cer- 
tain. 

With refpect to the influence of parents 

in producing this difeafe, }t deferves to 

be remarked, that in a family of many 

children, when one of the parents has 

B b 3 been 



382 PRAC T. I.C E 

been affected with fcrophula, and the 
other not ; as it is ufual for fome of the 
children to be in constitution pretty 
exatfly like the one parent, and others of 
them like the other ; it commonly happens, 
that thofe children who moft refemble the 
fcropulous parent become affected with 
fcropula, while thofe refembling the other 
parent entirely efcape. 

1 740. -The fcrophula generally appears 
at a particular period of life. It fel,dom 
appears in the firft, or even in the fecond 
year of a child's life ; and molt commonly 
it occurs from the fecond, or, as fome 
allege, and perhaps more properly, from 
the third to the feventh year. Frequent- 
ly, however, it difcovers itfelf at a later 
period ; and there are inftances of its 
firft appearance, at every period till the 
age of puberty ; after which, however, 
the firft appearance of it is very rare. 

1741. Whea 



OF PHYSIC. 383 

1 74 1. When it does not occur very 
early, we can -generally diftinguifh the 
habit of body peculiarly difpofed to 
it. It,moft commonly affects children 
of foft and flaccid habits, of fair hair and 
blue eyes ; or at leaft affects thofe much 
more frequently than thofe of an oppofite 
complexion. It affects efpecially children 
of fmooth fkins and rofy cheeks ; and 
fuch children have frequently a tumid 
upper lip, with a chop in the middle of it ; 
and this tumour is often confiderable, and 
extended to the columna nafi and lower 
part of the noftrils. The difeafe is fome-' 
times joined with, or follows rickets ; and 
although it frequently appears in children 
who have not had rickets in any great 
degree, yet it often attacks thofe who, 
by a protuberant forehead, by tumid 
joints, and a tumid abdomen, fhow that 
they had fome rachitic difpofition. In 
B b 4 parents 



384 PRACTICE 

parents who, without having had the 
difeafe themfelves, feem to produce fcro- 
phulous children, we can commonly per- 
ceive much of the fame habit and con- 
ftitution that has been juft now defcrib- 
ed. 

Some authors have fuppofed that the 
fmall-pox has a tendency to produce this 
difeafe ; and Mr De Haen afferts its 
following the inoculated, more frequently 
than the natural, fmall-pox. This lad 
pofition, however, we can confidently 
affirm to be a miftake ; although it mult 
be allowed, that in fact the fcrophula does 
often come on immediately after the 
fmall-pox. It is, however, difficult to find 
any connection between the two difeafes. 
According to my obfervation, the accident 
only happens in children who have pretty 
manifeftly the fcrophulous difpofitibn ; 
and I have had feveral inftances of the 
2 natural 






O F P H Y S I C. 385 

natural fmall-pox coming upon children 
affected at the fame time with fcrophula, 
not only without this difeafe being any 
ways aggravated by the fmall-pox,- but 
even of its being for foaie time after 
much relieved. 

1742. The fcrophula generally fhows 
itfelf firft at a particular feafon of the 
year ; and at fome time between ,the 
winter and fummer folftice ; but com- 
monly long before the latter period. It is 
to be obferved further, that the courfe of 
the difeafe is ufually connected with the 
courfe of the feafons. Whilft the tu- 
mours and ulcerations peculiar to this dif- 
eafe, appear firft in the fpring, the ulcers 
are frequently healed up in the courfe of 
the fucceeding fummer, and do not break 
out again till the enfuing fpring, to follow 
again with the feafon the fame courfe as 
before, 

1743. Frequently 



386 PRACTICE 

1 743. Frequently the firft appearance of 
the difeafe is the tumid and chopped lip 
above mentioned. Upon other occafions, 
the firft appearance is that of fimall 
fpherical or oval tumours, moveable under 
the fkin. They are foft, but with fome 
elaflicity. They are without pain ; and 
without any change in the colour of the 
fkin. In this ftate they often continue 
for a long time ; even for a year or two, 
and fometimes longer. Moft commonly 
they firft , appear upon the fides of the 
neck below the ears ; but fometimes alfo 
under the chin. In either cafe, they are 
fuppofed to affect in thefe places the con- 
globate or lymphatic glands, only j and 
not at all the falivary glands, till the 
difeafe is very greatly advanced. The 
difeafe frequently affects, and even at 
firft appears in, other parts of the body. 
In particular, it affects the joints of the 
elbows and ankles, or thofe of the fingers 
2 and 



O F P H Y S I C. 387 

and toes. The appearances about the 
joints are not commonly, as elfewhere, 
fmall moveable fwellings ; but a tumour 
almoft uniformly furrounding the joint, 
and interrupting its motion, 

1744. Thefe tumours, as I have faid, 
remain for fome time little changed ; and, 
from the time they firfh 'appeared in the 
fpring, they often continue in this way 
till the return of the fame feafon 
in the next or perhaps the fecond year 
after. About that time, however, or 
perhaps in the courfe of the feafon 
in which they firft appear, the tumour 
becomes larger and more fixed ; the fkin 
upon it acquires a purple, feldom a clear 
rednefs : but growing redder by degree?, 
the tumour becomes fofter, and allows 
the fluctuation of a liquid within to be 
perceived. All this procefs, however, 
takes place with very little pain attending 

it. 



3 88 PRACTICE 

it. At length fome part of the fkin be- 
comes paler ; and by one or more fmall 
apertures a liquid is poured out. 

1745. The matter poured out has at firfl: 
the appearance of pus, but it is ufually 
of a thinner kind than that from phleg- 
monic abfeeffes ; and the matter, as it 
continues to be difcharged, becomes daily 
lefs purulent, and appears more and 
more a vifcid ferum, intermixed with 
fmall pieces of a white fubftance refemb- 
ling the curd of milk. By degrees 
the tumour almoft entirely fubfides, while 
the ulcer opens more, and fpreads broad- 
er ; unequally, however, in different di- 
rections, and therefore is without any 
regular circumfcription* The edges of 
the ulcer are commonly flat and fmooth, 
both oil their outfide and their in- 
ner edge, which feldom puts on a cal- 
lous appearance. The ulcers, however, 

do 



O F P H Y S I C. 389 

do not generally fpread much, or become 
deeper ; but at the fame time their edges 
do not advance, or put on any appearance 
of forming a cicatrix. 

1 746. In this condition the ulcers often 
continue for a long time ; while new 
tumours, with ulcers fucceeding them in 
the manner above defcribed, make their 
appearance in different parts of the body. 
Of the firft ulcers, however, fome heal up, 
v hile other tumours and ulcers appear in 
ther vicinity, or in other parts of the 
b°dy and in this manner the difeafe pro- 
ceeds, iv^ne f the u l C ers healing up, at 
lealt to a ^ rtam degree, in the courfe of 
iummer, anc* breaking out in the fucceed- 
ing fpring: or^ t continues, by new tu- 
mours and ulcersfucceeding them, in the 
fpring fcafon, maring their appearance 
fuccefhvely for fevers, years. 

1747. In 



3$o PRACTICE 

1747. In this way the difeafe goes on 
for feveral years ; but very commonly in 
four or five years, it is fpontaneoufly cur- 
ed, the former ulcers being healed up, and 
no new tumours appearing : and thus at 
length the difeafe ceafes entirely, leaving 
only fome indelible efchars, pale and 
fmooth, but in fome parts fhrivelled ; or, 
where it had occupied the joints, leaving 
the motion of thefe impaired, or entirely 
deftroyed. 

1748. Such is the moil favoura^ e 
courfe of this difeafe ; and with us, xt 1S 
more frequently fuch, thanotherwj^ : out 
it is often a more violent, and foretimes a. 
fatal malady. In thefe cafes, daore parts 
of the body are at the fame- ime affected ; 
the ulcers alfo feeming to-5e imbued with 
a peculiarly iharp acrim>ny, and therefore 
becoming more deep, eroding, fpreading, 
jfcs well as feldomer dealing up. In fuch 

cafes, 



O F P H Y S I C. 291 

cafes, the eyes are often particularly affec- 
ted. The edges of the eye lids are affected 
with tumour and fuperficial ulcerations ; 
and thefe commonly excite obftinate in- 
flammation in the adnata, which fre- 
quently produces an opacity of the 
cornea. 

When the fcrophula efpecially affects 
the joints, it fometimes produces there 
confiderable tumours ; in the abfceffes fol- 
lowing which, the ligaments and cartilages 
are eroded, and the adjoining bones are af- 
fected with a caries of a peculiar kind. In 
thefe cafes, alfo, of more violent fcrophu- 
la, while every year produces a number 
of new tumours and ulcers, their acrimo- 
ny feems at length to taint the whole 
fluids of the body, occafioning various 
diforders ; and particularly a hectic fever, 
with all its fymptoms, which at length 

proves : 



392 



PRACTICE 



proves fatal, with fometimes the fymptoms 
of a phthiiis pulmonalis. 

1749. The bodies of perfons who have 
died of this difeafe fhow many of the vi£ 
cera in a very morbid ftate ; and particu- 
larly moft of the glands of the mefentery 
very much tumefied, and frequently in an 
ulcerated ftate. Commonly alfo a great 
number of tubercles or cyfts, containing 
matter of various kinds, appear in the 
lungs. 

1750. Such is the hiftory of the di£ 
eafe ; and from thence it may appear, that 
the, nature of it is not eafily to be afcer- 
tained. It feems to be a peculiar affection 
of the lymphatic fyftem ; and this in fome 
meafure' accounts for its connection with 
a particular period of. life. Probably* 
however, there is a peculiar acrimony of 
the fluids that is the proximate caufe of 

the 



OF PHYSIC. 393 

the difeafe ; although of what nature this 
is, has not yet been difcovered. It may 
perhaps be generally difrufed in the 
fyftem, and exhaled into the feveral cavi- 
ties and cellular texture of the body ; and 
therefore, being taken up by the abfor- 
bents, may difcover itfelf efpeciall'y in the 
lymphatic fyftem. This, however, wil^ 
hardly account for its being more confin- 
ed to that fyftem, than happens in the cafe 
of many other acrimonies which may be 
fuppofed to be generally difFufed. In 
fliort, its appearance in particular confti- 
tutions, and at a particular period of life, 
and even its being a hereditary- difeafe, 
which fo frequently depends upon the 
tranfmiffion of a peculiar conftitution, are 
all of them circumftances which lead me 
to conclude, upon the whole, that this dif- 
eafe depends upon a peculiar conjlitution of 
the lymphatic fyjl em. , 

Vol. IV. Cc 1751. It 



394 PRACTICE 

1 75 1. It feems proper to obferve here, 
that the fcrophula does not appear to be a 
contagious difeafe ; at leaft I have known 
many inttances of found children having 
had frequent and clofe intercourfe with 
fcrophulous children without being infec- 
ted with the difeafe. This certainly fhows, 
that in this difeafe the peculiar acrimony 
of it is, not exhaled from the furface of the 
body, but that it depends efpecially 
upon a peculiar conftitution of the fyk 

• 
1752. Several authors have fuppofect 
the fcrophula to have been derived from 
the venereal difeafe : but upon no juft 
grounds that I can perceive. In very ma- 
ny inftances, there can hardly be any fuA 
picion of the parents producing this dif- 
eafe having been imbued with fiphylis, or 
with any fiphylitic taint; and I have 
known feveral examples of parents con- 
veying 



O F P H Y S I G. 395 

vcying fiphylis to their offspring, in 
whom, however, no fcrophulous fym- 
ptoms at any time afterwards appeared. 
Further, the fymptoms of the two difeafes 
are very different ; and the difference of 
their natures appears particularly from 
hence, that while mercury commonly and 
readily cures the fiphylis, it does no fer- 
vice in fcrophula, and very often rather 
aggravates the difeafe. 

1753. For the cure of fcrophula, we 
have not yet learned any pra .lice that is 
certainly or even generally fuccefsful. 

The remedy which feems to be the 
mofl fuccefsful, and which our practition- 
ers efpecially trufl to and employ, is the 
ufe of mineral waters ; and indeed the 
warning out, by means of thefe, the lym- 
phatic fyflem, would feem to be a mea- 
fure promifing fuccefs : bu't in very many 
G c 2 inftances 



396 PRACTICE 

inftances of the ufe of thefe waters, I have 
not been well fatisfied that they had mort- 
ened the duration of the difeafe more than 
had often happened when no fuch remedy 
had been employed. 

1754. With regard to the choice of the 
mineral waters mod fit for the purpofe, I 
cannot with any confidence give an opi- 
nion. 

Aim oft all kinds of mineral waters, 
' whether chalybeate, fulphureous, or faline, 
have been employ, d for the cure of fcro- 
phula, and feemingly with equal fuccefs 
and reputation :- a circumftance which 
leads me to think, that, if they are ever 
fuccefsful, it is the elementary water 
that is the chief part of the remedy. 

Of late, fea- water has been especially re- 
commended and employed ; but after nu- 
merous 



O F P H Y S I C. 397 

merous trials, I cannot yet difcover its fu- 
perior efficacy. 

1 755. The other remedies propofed by 
practical writers are very numerous ; but, 
upon that very account I apprehend they 
are litthe to be trufted : and as I cannot 
perceive any juft reafon for expecting fuc- 
cefs from them, 1 have very feldom em- 
ployed them. 

Of late, the Peruvian bark has been 
much recommended : and as in fcrophu- 
lous perfons there are generally ibme 
marks of laxity and flaccidity, this tonic 
may poflibly be of fervice ; but in a 
great variety of trials, I have never feen 
it produce any immediate cure of the di£ 
cafe. 

In feveral infta T i"es, the leaves of colts- 
foot have appeared to me to' be fuccefs- 
C c 3 • fuJ. 



398 PRACTICE 

ful. I have ufed it frequently in a ftrong 
decoction, and even then with advantage ; 
but have found more benefit from the ex- 
preffed juice, when the plant could be had 
in fomewhat of a fucculent date, foon after 
its firft appearance in the fpring. 

1756. I have alfo frequently employed 
the hemlock, and have fometimes found it 
ufeful in difcufling obftinate fwellings : 
but in this, it has alfo often difappointed 
me ; and' I have not at any time obferyed 
that it difpofed fcrophulous ulcers to heal. 

I cannot conclude the fubjecl: of inter- 
nal medicines without remarking, that I 
have never found either mercury or anti- 
mony, in any fhape, of ufe in this difeafe j 
and when any degree of a feverifh {late 
had come on, the ufe of mercury proved 
manifeftly hurtful. 

1757. In 



OF PHYSIC. 3 99 

1757. In the progrefs of fcrophula, feve- 
ral external medicines are requifite. Seve-* 
ral applications have been ufed for difcufc 
fing the tumours upon their firft coming 
on ; but hitherto my own practice, hi 
thefe refpects, has been attended with ve* 
ry little fuccefs. The fblution of faccha- 
rum faturni has feemed to be ufeful ; but 
it has more frequently failed t And I 
have had no better fuccefs with the fpiri- 
tus Mindereri. Fomentations of every 
kind have been frequently found to do 
harm ; and poultices feem only to hurry 
on a fuppuration. I am doubtful if this 
laft be ever praclifed with advantage ; for* 
fcrophulous tumours fometimes fponta- 
neoufly difappear, but never after any de- 
gree of inflammation has Came upon them ; 
and therefore poultices, which commonly 
induce inflammation, prevent that difcufc 
fion of tumors, which might otherwife 
have happened. 

C c 4 Even 



400 PRACTICE 

Even when fcrophulous tumours have 
advanced towards fuppuration, I am un- 
willing to haften the fpontaneous opening, 
or to make it by the lancet ; becaufe I ap, 
prehend the fcrophulous matter is liable to 
be rendered more acrid by communication 
with the air, and to become more eroding 
and fpreadihg than when in its inclofed 
ftate. 

1758. The management of fcrophulous 
ulcers has, fo far as I know, been as little 
fuccefsful as that of the tumours. Efcha- 
rotic preparations, of either mercury or 
copper, have been fometimes ufeful in 
bringing on a proper fuppuration, and 
thereby difpofing the ulcer to heal ; but 
they have feldom fucceeded, and more 
commonly have they caufed the ulcer to 
fpread more. The efcharotic from which 
I have received moft benefit is burnt alum, 

and 



OF PHYSIC. 401 

and a portion of that mixed with a mild 
ointment, has been as ufeful an application 
as any I have tried. The application, 
however, that I have found mod' fer- 
viceable and very univerfally admiflible, is 
that of linen cloths wetted with cold wa- 
ter, and frequently changed when they are 
becoming dry, it being inconvenient to let 
them be glued to the fore. They are 
therefore to be changed frequently during 
the day ; and a cloth fpread with a mild 
ointment or plafter may be applied 
for the night. In this practice I have 
fometimes employed fe a- water,, but gene- 
rally it proved too irritating j and neither 
that nor any mineral water has appear- 
ed to be of more fervice than common 
water. 

1759. To conclude what I have to offer 
upon the cure of fcrophula, I muft ob- 

ferve, 



4©2 PRACTICE 

ferve, that cold bathing feems to have 
been of more benefit than any other re- 
medy that I have had occafion to fee em- 
ployed. 



CHAP. 



OF PHYSIC. - 403 



GHAP, II. 



©F 



S IP H Y L I 5, 



OR TH£ 



VENEREAL DISEASE. 



1760. A FTER practitioners have Lad 
**• •*■ fo much experience in treat- 
ing this difeafe, and after fo many books 

have 



404 - PRACTICE 

have been publifhed upon this fubjecT:, 
it does not feem neceflary, or even pro- 
per, for me to attempt any full treatife 
concerning it ; and I Ihall therefore con- 
fine myfelf to fuch general remarks, as 
may ferve to illuftrate fome parts of the 
pathology or of the practice. 

1.7.6 1. It is fufficiently probable, that 
H/ anciently, in certain parts of Afia, where 
the leprofy prevailed, and in Europe 
after that difeafe had been introduced 
into it, a difeafe of the genitals refem- 
bling that which now commonly arifes 
from fiphylis, had frequently appeared : 
but it is equally probable, that a new 
difeafe, and what we at prefent term 
Siphylis, was firft brought into Europe a- 
bout the end of the fifteenth century ; 
and that the diftemper now fo frequent- 
ly occurring, has been very entirely de- 
rived from that which was imported 

from 



O F P H Y S I C. 405 

from America ' at the period mention- 
ed*. 

1762. This difeafe, at leaft in its prin- 
cipal circumftances, never arifes in any 
perfon but from fome communication' * 
with a perfon already affected with it. It 

is 

* Various opinions have been held by different phyfi- 
cians about the orgin of this difeafe ; fome fuppofing 
it to have exifted in the old world, while others think it 
was imported from the new veorld, difcovered by 
Columbus. The difpute produced many controverfial 
traces, from the perufal of which, the young practitioner 
can gain little advantageous knowledge. All that 'we 
certainly know about the origin of the difeafe is, that 
it was firft obferved among the French, when they were 
at Naples in the year 1493, and that it was brought into 
France by the French who returned thither with Charles.. 
Columbus landed at Palos on the 15th of March in 
the fame year, on his return from his firfl. voyage. The 
difeafe therefore, if imported by Columbus's crew, mult 
have fpread rapidly through Europe. 



4 o6 PRACTICE 

is mod commonly contracted in confe- 
quence of coition with an infected per- 
fon; but in what manner the infection is 
communicated, is not clearly explained. 
I am perfuaded, that in coition, it is com- 
municated without there being any open 
ulcer either in the perfon communicat- 
ing, ' or in the perfon receiving the infec- 
tion ; but in all other cafes, I believe it 
is never communicated in any other way 
than by a contact of ulcer, either in the 
perfon communicating, or in the perfon 
receiving the infection. 

1763. As it thus arifes from the con- 
tact of particular parts, fo it always ap- 
pears firft in the neighbourhood of the 
parts to which the infecting matter had 
been immediately applied ; and therefore, 
as mod commonly contracted by coi- 
tion, it generally appears firft in the ge- 
nitals. 

1764. After 



I # 



O F P H Y S I C 407 

1764. After its firft appearance in par- 
ticular parts, more efpecially when thefe 
are the genitals of either fex, its effects 
for fome time feem to be confined to 
thefe parts ; and indeed, in many cafes, 
never extends further. In other cafes, 
however, the infecting matter paffes from 
the parts firft affected, and from the ge- 
nitals, therefore,- into the blood-veffels ; 
and being there diffufed, produces difor- 
ders in many other parts of the body. 

From this view of the circumflances 1 , 
phyficlaris have very properly diftinguifh- 
cd the different ftates of the difeafe, ac- 
cording as they are local or are more uni- 
verfal. To the former, they have adapt- 
ed appellations fuited to the manner in 
which the difeafe appears ; and to the o- 
ther the general affection, they have al- 
moft totally confined the appellations of 
lis % Lues Venerea, or Tox. In the 

remarks 



4 oS PRACTICE 

remarks I am now to offer, I fhall begin 
■with confidering the local affection* 

1765. This local affection appears chief- 
ly in the form of gonorrhoea or chan- 
cre. 

The phenomena of gonorrhoea, either 
■upon its firft coming on, or in its 
after progrefs, or the fymptoms of ardor 
urinas, chordee, or others attending it, it 
is not neceflary for me to defcribe. 1 fhall 
only here obferve, that the chief circum- 
ftance to be taken notice of, is the inflam- 
ed (late of the urethra, which I take to be 
infeparable from the difeafe. 

1766. In thefe well known circum- 
ftances, the gonorrhoea continues for a 
time longer or fhorter, according to the 
conftitution of the patient ; it ufually re- 
maining longed in the moft vigorous and 

1 v *pb.mt 



O F P H Y S I C. 409 

robuft, or according to the patient's regi- 
men, and the care taken to relieve or 
cure the difeafe. In many cafes, if by 
a proper regimen the irritation of the in- 
flamed (late is carefully avoided, the go- 
norrhoea fpontaneoufly ceafes, the fym- 
ptoms of inflammation gradually abating, 
the matter difcharged becoming of a 
thicker and more vifcid confidence, as well ' 
as of a whiter colour ; till at length, the 
flow of it ceafes altogether ; and whether 
it be thus cured fpontaneoufly, or by 
art, the difeafe often exifts without com- 
municating any infection to the other 
parts of the body. 

1767. In other cafes, however, the 
difeafe having been neglected, or by an 
improper regimen aggravated, it conti- 
nues with all its fymptoms for a long 
time ; and produces various other dis- 
orders in the genital parts, which, as 

Vol. IV. D d commonly 



4io PRACTICE 

commonly taken notice of by authors, 
need not be defcribed here. I fhall only 
obferve, that the inflammation of the u- 
rethra, which at firft feems to be feated 
chiefly, or only, in its anterior parts, 
is, in fuch neglected and aggravated 
cafes, fpread upwards along the urethra, 
even to the neck of the bladder. In thefe 
circumftances, a more considerable in? 
flammation is occafioned in certain parts 
of the urethra j and confequently, fup- 
puration and ulcer are produced, by 
which the venereal poifon is fometimes 
communicated to the fyftem, and gives 
rife to a general fiphylis. 

1768. It was fome time ago a pretty 
general fuppofition, that the gonorrhoea 
depended always upon ulcers of the 
urethra, producing a difcharge of puru- 
lent matter ; and fuch ulcers do indeed 
jfometimes occur in the manner that has 
3 ; tee^ 



O F P H Y S I C. 4 ii 

been juft now mentioned. We are now 
aflured, however, from many difTeclions 
of perfons who had died when labouring 
under a gonorrhoea, that the difeafe may 
exift, and from many confiderations it is 
probable that it commonly does exift, 
without any ulceration of the urethra ; 
fo that the difcharge which appears, is 
entirely that of a yitiated mucus from 
the mucous follicles of the urethra. 

1769. Although mod of the fymptoms 
of gonorrhoea Ihould be removed, yet it 
often happens that a mucous fluid con- 
tinues to be difcharged from the urethra 
for a long time after, and fometimes for 
a great part of a perfon's life. This dif- 
charge is what is commonly called a 
Gleet. 

With refpect to this, it is proper to ob- 

ferve, that in fome cafes, when it is cer- 

D d 2 tain 



412 PRACTICE 

tain the matter difcharged contains no 
venereal poifon, the mattter may, and 
often does, put on that puriform appear- 
ance, and that yellow and greenifh colour, 
•which appears in the difcharge at the be- 
ginning and during the courfe of a viru- 
lent gonorrhoea. Thefe appearances in the 
matter of a gleet, which before had been 
of a lefs coloured kind, have frequently 
given occafion to fuppofe that a frefh in- 
fection had been received : but I am cer- 
tain that fuch appearances maybe brought 
on by, perhaps, various other caufes ; and 
particularly, by intemperance in venery 
and drinking concurring together. I 
believe,, indeed, that this feldom happens 
to any but thofe who had before fre- 
quently laboured under a virulent gonor- 
rhoea, and have more or lefs of gleet re- 
maining with them : but I mull alfo ob- 
serve, that in perfons who at no period of 
their life had ever laboured under a vi- 
rulent 



OF PHYSIC. 413 

rulent gonorrhoea, or any other fym- 
ptom of fiphylitic affection, I have met 
with inftances of difcharges from the 
urethra refembling thofe of a virulent 
gonorrhoea. 

The purpofe of thefe obfervations is, to 
fuggeft to practitioners what I have not 
found them always aware of, that in per- 
fons labouring under a gleet, fuch a return 
of the appearances of a virulent gonorrhoea 
may happen without any new infection 
having been received, and confequently 
not requiring the treatment which a new 
infection might perhaps demand. When, 
in the cure of gonorrhoea, it was the prac- 
tice to employ purgatives very frequently, 
and fometimes thofe of the draftic kind, 
I have known the gleet, or fpurious gonor- 
rhoea by fuch a practice much increafed. 
and long continued, and the patient's con- 
ftitution very much hurt. Nay in order 
D d 3 more 



4*4 PRACTICE 

more certainly further to prevent miftakes^ 
it is to be obferved, that the fpurious go- 
norrhoea is fometimes attended with heat 
of urine, and fome degree of inflamma- 
tion ; but thefe fymptoms are feldom con- 
fiderable, and, merely by the afhftance of 
a cool regimen, commonly difappear in a 
few days. 

1770. With refpecl to the cure of a vi- 
rulent gonorrhoea, I have only to remark, 
that if it be true, as 1 have mentioned a- 
bove, that the difeafe will often, under a 
proper regimen, be fpontaneoufly cured ; 
and that the whole of the virulent matter 
may be thus entirely difcharged without 
the affiftance of art ; it would feem that 
there is nothing required of practitioners, 
but to moderate and remove that inflam- 
mation which continues the difeafe, and 
pccalions all the troublefome fymptoms 
that ever attend it. The fole bufinefs 

therefore 



O F P H Y S I C. 4 ij 

therefore of our art in the cure of gonor- 
rhoea, is to take off the inflammation ac- 
companying it : and this I think may com- 
monly be done, by avoiding exercife, by 
ufing a low and cool diet, by abftaining 
entirely from fermented and fpirituous li- 
quors, and by taking plentifully of mild 
diluent drinks *. 

D d 4 1771. The 

* This fimple method of curing a gonorrhoea is, in 
inany cafes, fufficient : but it can only be depended on 
when the difeafe is flight and the patient of a healthy 
conflitution. As every virulent gonorrhoea is evident- 
ly produced by the aftion of the veneral poifon, the 
judicious practitioner will feldom trull to this method, 
without the ufe of mercurials after the inflammatory 
fymptoms have been fomewhat fubdued. They ought 
to be given in fuch cafes in very fmall quantities, fo 
as to produce only a flight effecl: on the mouth ; and 
their ufe ought to be continued till every fymptom dif- 
appears. 

Mercury 



4 i6 P R A C T I C £ 

1771. The heat of urine, which is Co 
troublefome in this difeafe, as it arifes from 
the increafed fenlibility of the urethra in 

its 



Mercury may be ufed either internally or externally 
as occafion may require ; if it does not affect the bowels 
nor purge, the common mercurial pill of the Edinburgh 
pharmacopoeia is as good a formula as any we have in the' 
fhops. Its dofe muft be regulated by the effects it pro- 
duces. In general, we begin with a four grain pill 
every night, and continue that quantity till, the gums 
be (lightly affected, or a coppery tafte be perceived in 
the mouth. When either of thefe fymptoms appear, 
we are certain that the mercury is received, in a fuf- 
ficient quantity, into the general mafs of the blood, for 
deftroying the veneral virus ; and then a pill may be 
given once in two or three days, fo as to keep up the 
fame flight affection of the mouth, but without increaf- 
ing it. If the pill purges, we then are to have recourfe 
to the ftrong mercurial ointment, half a drachm of which 
muft be rubbed into the hams night and morning, till 
the mouth be affefted in the manner above described, 
The patient ought to wear flannel drawers during the 
whole time of the continuing the rubbing, which ought 

t& 



O F P H Y S I C. 4 i 7 

its inflamed ftate ; fo, on the other hand, 
the irritation of the urine has the ef- 
fect of increasing the inflammation, and is 
therefore to be removed as foon as po£ 
fible. This can be done moft effectually 
by taking in a large quantity of mild wa- 
tery liquors. Demulcents may be employ- 
ed ; but unlefs they be accompanied with 
a large quantity of water, they will have 
little effed *. Nitre has been commonly 
employed as a fuppofed refrigerant : but, 
from much obfervation, I am convinced, 

that 

to be regulated by the degree of affeaion perceived in the 
mouth* The ufe either of the pill, or of friftion, muft 
be continued eight or ten days after every fymptom of 
the difeafe has difappeared. 

Lintfeed tea, a very thin deco&ion of marfh-mallow 
root, or thin barley water, will, in moft cafes, anfwer 
the intention fufficiently well; The common almond 
emulfion has been recommended in thefe cafes, and whea 
taken in large quantities is certainly very efficacious. 
It may be ufed as the patient's common drink. 



4*8 PRACTICE 

that in a fmall quantity it is ufelefs, and iri 
a large quantity certainly hurtful f ; and, 
for this reaibn, that every faline mat- 
ter pafling with the urine generally gives 
fome irritation to the urethra. To prevent 
the irritation of the urethra arifing from 
its increafed fenfibility, the injection of 
mucilage or of mild oil into it has been 
praftifed ; but I have feldom found this of 
much fervice. 

1772. In gonorrhoea, as coftivenefs may 
be hurtful, both by an irritation of the 
fyftem in general, and of the urethra in 

particular, 



t The ufe of nitre has been ftrongly recommended by 
many pra&ical writers, in cafes of fimple gonorrhoea un- 
accompanied with this fymptom ; but it muft be acknow- 
ledged, as the author juftly obferves, to be hurtful by it* 
irritating quality. It is certainly a refrigerant, and as- 
fuch is ufeful in allaying the inflammatory fymptoms } 
but it is inadmiffible in cafes where the ardor urinae is 
violent. 



OF PHYSIC. 419 

particular, as this is oecafioned always by 
the voiding of hardened fseces j fo coftive- 
nefs is to be carefully avoided or removed ; 
and the frequent ufe of large glyflers of 
water and oil, I have found of remarkable 
benefit in this difeafet If glyflers, how- 
ever, do not entirely obviate coftivenefs, it 
will be necefTary to give laxatives by the 
mouth : which, however, mould be of the 
mildeft kind, and ihould do no more than 
keep the belly regular and a little loofe, 
without much purging % 

The practice of frequent purging, 

which 



* A tea fpoonful of the following electuary taken oc- 
*afionaIly will keep the belly fufficiently open. 

R. Pulv. Jalap. 31. 
Nitri 3ii. 
Ele&. Lenitiv. li. 
Syr. fimpl. q. s. 
M.'f. Eleft. 



420 PRACTICE, 

■which was formerly fo much in uie, 
and is not yet entirely laid afide, has al- 
ways appeared to me to be generally 
fuperflnous, and often very hurtful* 
Even what are fuppofed to be cooling 
purgatives, fuch as Glauber's fait, foluble 
tartar, and cry ftals of tartar, info far as 
any part of them pafs by urine, they, in 
the fame manner as we have faid of ni- 
tre, may be hurtful ; and fo far as they 
produce very liquid {tools, the matter of 
which is generally acrid, they irritate the 
rectum, and confequently the urethra. 
This laft effect., however, the acrid, and 
in any degree draftic, purgatives, more 
certainly produce. 

1773. In cafes of a gonorrhoea attend- 
ed with violent inflammation, blood-lett- 
ing may be of fervice ; and in the cafe of 
perfons of a robuft and vigorous habit, 
in whom the difeafe is commonly the 

moll 



O F P H Y S I C. 42 r 

moil violent, blood-letting may be very 
properly employed. As general bleed- 
ings, however, when there is no phlo- 
' gillie diathefis in the fyftem, have little 
effedl in removing topical inflammation ; 
fo in gonorrhoea, when the inflammation 
is conliderable, topical bleeding applied 
to the urethra by leeches, is generally 
more effectual in relieving the inflamma" 
tion e . 

1774. When there is any phymofis at- 
tending a gonorrhoea, emollient fomenta- 
tions applied -to the whole penis are often 

of 

* The good effefts of leeches in thefe cafes are con- 
firmed by experience. They may be applied on the un- 
der fide of the penis, and three or four thus applied 
have frequently produced amazing effects. The opera- 
tion, however, is extremely painful, and is feldom fub- 
mitted to a fccond time by a patient who has once ex- 
perienced it, 



422 PRACTICE' 

of fervice. In fuch cafes it is neceiTary, 
and in all others ufeful, to keep the penis 
laid up to the belly, when the patient ei- 
ther walks about or is fitting "f\ 

1775. Upon occafion of frequent pri- 
apifm and chordee, it has been found ufe- 
ful to apply to the whole of the penis a 
poultice of crumb of bread moiftened with 
a ftrong folution of fugar of lead. I have, 
however, been often difappointed in this 
practice, perhaps by the poultice keeping 
the penis too warm, and thereby exciting 
the very fymptoms I wifhed to prevent. 
Whether lotions of the external urethra 

with, 



f In all cafes of inflammation of the urethra thefe en 
molient applications give great relief. The common 
white bread poultice may be ufed during^the night time, 
or while the patient is in bed ; and warm flannels, inv> 
pregnated with lintfeed tea while he is fitting up. 



6 F P H Y S I C 423 

with a folution of the fugar of lead, might 
be ufeful in^his cafe, I have not properly 
tried *. 

1 776. With rcfpecl to the ufe of injec- 
tions, fo frequently employed in gonor- 
rhoea, I am perfuaded, that the early ufe 
of aftringent injections is pernicious ; 
not by occafioning a fiphylis, as has 
been commonly imagined ; but by in- 
creafing and giving occafion to all the 
confequences of the inflammation, parti- 
cularly to the very troublefome fymptoms 

of 



* The fugar of lead folution may perhaps be object- 
ed againft, on account of its flopping the difcharge, and 
inducing a fwelled tefticle, which has fometimes followed 
its application. Wrapping the penis up in linen rags 
wet with cold water, frequently anfwers the purpofe of 
preventing the violence of the fymptoms, as well as any 
more complicated application. The cold wet rags ought 
to be renewed whenever they grow warm. 



424 PRACTICE 

of fwelled tefticles. When, however, the 
difeafe has continued for fome time, and 
the inflammatory fymptoms have very- 
much abated, I am of opinion, that by 
injections of moderate aftringency, or at 
leaft of this gradually increafed, an end 
may be fooner put to the difsafe than 
would otherwife have happened ; and that 
a gleet, fo readily occurring, may be ge- 
nerally prevented *. 

1777. Befides 



* -The practice of ufing aftringent injections is ex- 
tremely common ; but, as the author juftly obferves, 
their ufe is frequently attended with difagreeable con- 
fequences. In general they always do harm when ufed 
during the continuance of the inflammatory fymptoms, 
or even too foon after thefe fymptoms have difappeared. 
If, however (after the inflammatory fymptoms are 
overcome, and mercury has been ufed for fix weeks or 
two months in the manner defcribed in the note on arti- 
cle 1772J the running flill continues, we nw then have 
recourfe to thefe ailrin'gent injections. They may be 

made 



OF PHYSIC. 4 2£ 

1777. Befides the ufe of aftringent in- 
jections, it has been common enough to 
employ thofe of a mercurial kind. With 
refpect to thefe, although I am convinced 

that 

made of fugar of lead and white vitriol well diluted with 
Water, as in the following formula. 

R. Plumb, acetat. 

Zinc, vitriolat. aa 3fs. 

Aq. font, gviii- 

M. et cola per chartam. 

Half an ounce of this inje&ion (lightly warmed may- 
be, thrown up into the urethra^ twice a-day ; but if it 
produce any fmarting, it ought to be diluted with mor« 
Water. 

Solutions of copper have alfo been ufed with advan- 
tage in thefe cafes, but they are of fo corrofive a nature, 
as frequently to do harm, if not very much diluted. 
• 

An imprudent or too frequent ufe of any of thefe in- 
jections, efpecially if they are too ftrong or not fuffi- 

VoL. IV. E e eiently 



426 PRACTICE 

that the infection producing gonorrhoea, 
and that producing chancres and fiphylis, 
are one and the fame ; yet I apprehend, 
that in gonorrhoea mercury cannot be of 
life by correcting the virulence of the in- 
fection : and therefore that it is not uni- 
verfally neceflary in this difeafe. 1 am 
perfuaded, however, that mercury ap- 
plied to the internal furface of the ure- 
thra, may be of ufe in promoting the 
more full and free dil'charge of virulent 
matter from the mucous glands of it. U- 
pon this fuppofition, I have frequently 
employed mercurial injections ; and, as I 
judge, with advantage ; thole injections 
often bringing on fuch a ftate of the con- 
fidence 



ciently diluted, fometimes inflames or even eScoriates- 
the urethra, and hence much mifchief arifes. The cau- 
tious practitioner muft therefore never ufe them fo flrong 
as to produce much fmarting. 



OF PHYSIC. 427 

fiftence and colour of the matter difcharg- 
ed, as we know ufually to precede its 
fpontaneous ceafing. I avoid thefe injec- 
tions, however, in recent cafes, or while 
much inflammation is ftill prefent ; but 
when that inflammation has fomewhat a- 
bated, and the difcharge ftill continues in 
a virulent form, I employ mercurial in- 
jections freely. I employ only thofe that 
contain mercury entirely in a liquid form, 
and avoid thofe which may depoiite an a- 
crid powder in the urethra. That which 
I have found mofl ufeful is a folution of 
the corrofive fublimate in water ; Co much 
diluted as not to occafion any violent 
fmarting, but not fo much diluted as to 
give no fmarting at all. It is fcarce ne- 
ceflary to add, that when there is reatbqi 
to fufpect there ' are ulcerations already 
formed in the urethra, mercurial injec- 
tions are not only proper, but the only ef- 
fectual remedy that can be employed. 

E e 2 1778. With' 



428 PRACTICE 

1778. With regard to the cure of go- 
norrhoea, I have only one other remark 
to offer. As moil of the fymptoms arife 
from the irritation of a ftimulus applied, 
the effects of this irritation may be often 
leffened by diminifhing the irritability 
of the fyftem ; and it is well known, that 
the mod certain means of accomplifhing 
this is by employing opium. For that 
reafon, I confider the practice both of ap- 
plying opium directly to the urethra*, 
and of exhibiting it by the mouth, to be 
extremely ufeful in moil cafes of gonor- 
rhoea. 

1779. After 

* Opium may be very conveniently applied to the 
urethra by injection; and for this purpofe a diluted 
folution of opium in water is preferable to a fpirituous 
or vinous folution. A grain of opium diflblved in an 
ounce of water, and the folution ftraihed, may be inject- 
ed twice or thrice a-day ; and thirty or forty drops of 
laudanum may be given every night at bed time. 



OF PHYSIC. 429 

1779. After thus offering fome remarks 
with refpect to gonorrhoea in general, I 
ought to proceed to confider particular- 
ly the various fymptoms which fo fre- 
quently attend it ; but it does not feem 
neceffary for me to attempt this after the 
late publications of Dr Foart Simmons, 
and of Dr Schwediaur, who have treated 
the fubjecl: fo fully, and with fo much 
difcernment and ikill *. 

E e 3 1780. The 

* As a fwelled tefticle frequently attends a fupprefied 
gonorrhoea, it may be proper to give the young prac- 
titioner fome directions concerning the management 
of it. ' 

Sometimes without any other preceding fymptom, 
but generally on a premature flopping of a gonorrhoea, 
a pain is felt in the fpermatic veflels and epididymis. 
The pain continuing, the veflels and epididymis begin 
to fwell, and the pain and fwelling are foon communi- 
cated to the tefticle. 

la 



43o PRACTICE 

1780. Tbe other form of the local af- 
fe&ion of fiphylis, is that of chancre. The 
ordinary appearance of this I need not 

defcribe, 



Tn thefe cafes, we muft. confine the patient to his bed, 
bleed him if the inflammatory diatbefis appeals to be 
liniverfal ; but, if not, three or four leeches n ay be ap- 
plied to the inflamed part. A brifk purge muff, be 
given, for which purpofe an ounce of Glauber's Salt, 
with a large quantity of water, anfvvers fufficiently 
well. Cold pledgets foaked in a fclution of Sugar of 
Lead, defcriled in the note on Article 267. muft be ap- 
plied to the fcrotum, and their place fupplied with frelh 
cold oner,- as often as they grow warm by lying on the 
part. A warm poultice of bread and milk, muft. be alfo 
applied to the glans penis cr to the whole penis. N The 
patient muft be kept on a very fpare diet, ufing for his 
drink cold water with a fcruple of nitre in each pint of 
it. Ihis regimen generally allays the violence of the 
fymptoms within twenty-four hours ; but, it will be ne- 
cefkiry to continue the ufe of the cold pledgets and 
warm poultice for three or four days, or longer, and to 
repeat the purge. After the pain and fwellmg have been 
completely removed, the patient may lit up, but it will 

be 



OF PHYSIC. 



43* 



defcribe, it having been already fo often 
done. Of the few remarks I have to offer, 
the firft is, that I believe chancres never 
appear in any degree without immediately 
communicating to the blood more or lefs 
E e 4 of 

be prudent for him to ufe a fufpenfory bandage for the 
fcrotum, as the weight of the tefticles, by ftretching the 
fpermatic chords, will be apt to occaiion the return of 
all the fymptoms. 

Sometimes the gonorrhoea, if it had preceded the fwel- 
lings of the epididymis and tefticles, will be again 
brought on ; but, it likewife fometimes happens, that, 
on difcuffing the tumour in the fcrotum, the glands of 
the groin, begin to be painful and to fwell. In thefe 
cafes we muft apply cold pledgets to thefe glands as 
well as to the fcrotum ; and rub, at the fanie time, feme 
ftrong mercurial ointment on the infide of the thighs, 
in the courfe of the lymphatics going to thefe glands ; 
and, if the penis be not inflamed, half a drachm or a 
fcruple of mercurial ointment ought to be rubbed 
on the bafe of the glans penis in the infida of the pre- 
puce. 

Such 



432 PRACTICE 

of the venereal poifon : for I have con- 
ftantly, whenever chancres had appeared, 
found, that unlefs mercury was immedi- 
ately given internally, fome fymptoms of 
a general fiphylis did certainly come on 
afterwards, and though the internal ufe 
of mercury mould prevent any fuch ap- 
pearance, it is ftill to be prefumed that 
the poifon' had been communicated, be- 
caufe mercury could act upon it in no 
other manner than as diffufed in the 
fluids. 

1 78 1. It has been a queftion among 
practitioners, upon the fubjecT: of chancres, 
Whether they may be immediately healed 
up by applications made to the chancres, 
or if they mould be left open for fome 

time 



Such is the general method of treating cafes of this 
kind, and a prudent continuation of it feldoms fails of, 
fuccefs, 



O F P H Y S I C 433 

time without any fuch application ? It has 
been fuppofed, that the fudden healing up 
of chancres might immediately force into 
the blood a poifon, which might have 
been excluded by being difcharged from 
the chancre. This, however, is a fup- 
pofition that is very doubtful ; and, upon 
the other hand, I am certain, that the 
longer a chancre is kept open, the more 
poifon it perhaps generates, and certainly 
fupplies it more copioufly to the blood. 
And although the above mentioned fup- 
pofition were true, it will be of little con- 
fequence, if the internal ufe of the mercury, 
which I judge neceffary in every cafe of 
chancre, be immediately employed. I have 
often feen very troublefome confequences 
follow from allowing chancres to remain 
unhealed ; and the fymptoms of general 
fiphylis have always feemed to me to be 
more confiderable and violent in propor-r 
tion as chancres had been fufFered to re-r 

majn. 



434 PRACTICE 

main longer unhealed : They mould al- 
was, therefore, be healed as Toon as pof- 
fible ; and that by the only very effectual 
means, the application of mercurials to 
the chancre itfelf. 1 hofe that are recent, 
and have not yet formed any confiderable 
ulcer may often be healed by the com- 
mon mercurial ointment ; but the moft 
powerful means of healing them has ap- 
peared to me, to be the application of red 
precipitate in a dry powder *. 

1782. When, in confequence of chancres, 

or 



* Although chancres may be very fpeedily healed by 
red precipitate alone, y<-r it will be necelTary fometimes 
to ufe an ointment * made of* the red precipitate and 
twice or thrice its weight of freih hogs lard : The pre- 
cipitate will by this means be more conflantly kept on 
the part. The practitioner, however, mull be cautious 
left he ufe too great a quantity of precipitate, which, by 
1 its 



OF PHYSIC. 435 

or of the other circumftances above men- 
tioned, by which it may happen the ve- 
nereal poifon has been communicated to 
the blood, it produces many different 
fymptoms in different parts of the body, 
not neceffary to be enumerated and de- 
fcribed here, that having been already- 
done by many authors with great accu- 
racy. 

1783. Whenever 



its corrofive quality, fometimes increafes the ulcer it was 
meant to heal. 

During the ufe of this application, it will be necefTary 
alfo to ufe mercury either internally or externally, in the 
manner defcribed in the note on article 1770. 

The application of the lapis infernalis to chancres, 
comes recommended to us on the authority of fome 
eminent practitioners. It is however a dingercus ap- 
plication, and frequently produces ulcers that are ex- 
tremely difficult to heal. 



436 PRACTICE 

1783. Whenever any of thofefymptoms 
do in any degree appear, or as foon as 
it is known that the circumftances which 
give occafion to the communication of 
the venereal poifon has taken place, I hold 
the internal ufe of mercury to be im* 
mediately neceflary ; and I am well per- 
fuaded, that mercury employed without 
delay, and in fufEcient ■ quantity, will 
pretty certainly prevent the fymptoms 
which would otherwife nave foon ap- 
peared, or will remove thofe that may 
have already difcovered themfelves. In 
both cafes, it will fecure the perfon 
from any future confequences of fiphylis 
from that infection, 

1784. This advice for the early and full 
ufe of mercury, I take to be the moft im- 
portant that can be given with refpecl to 
the venereal difsafe : And although I muft 
aelmit that the virulence of the poifon 

may 



'OF PHYSIC. 437 

may be greater in one cafe than in an- 
other, and even that one conftitution may 
be more favourable than another to the 
violence of the difeafej yet I am tho- 
roughly convinced, that moft of the in- 
ftances which have occurred of the vio- 
lence and obftinacy of fiphylis have been 
owing very entirely to the neglect of the 
early application of mercury *. 

1785. Whatever other remedies f of 

fiphylis 

* In a word, mercury is a certain fpecific for fiphylis, 
and a fure antidote againft the venereal poifon. If it be 
properly ufed, it feldom fails of producing a cure ; and 
this cure will always be the more fpeedy, in proportion, 
as mercury has been ufed in the earlier ftage of the 
difeafe. 

f We have no occafion to feek for other remedies 
than mercury ; and the practitioner who rifles his 
patient's health, and his o\Vn reputation, on the un- 
certain effects of other remedies, furely deferves re- 
prehenfion. 



438 PRACTICE 

fiphylis may be known, or may here- 
after be found out, I cannot pretend re- 
determine : but i am well perfuaded that 
in mod cafes mercury properly employ- 
ed will prove a very certain and effectual 
remedy. With refpecl to others that have 
been propofed, I frull offer this remark 
only, that i have found the decoction of 
the mezereon contribute to the healing 
of ulcers which feemed to have refilled 
the power of mercury. 

1786. With regard to the many and 
various preparations of mercury, 1 do not 
think it neceffary to give any enumeration 
of them here, as they are commonly very 
well known, and have been lately well 
enumerated by, Dr Schwediaur. The 
choice of them feems to be for the moft 
part a matter of indifference ; as I believe 
cures have been, and (till may be, effected 
by many different preparations, if proper- 

3 iy 



O F P H Y S I C. 439 

ly adminiflered. The proper adminiftra- 
tioi^ * feems to conuft., ]Ji i In the choos- 
ing thofe preparations which are the 
lead ready to run ofi by ftool ; and 
therefore the applications externally by 
unction are in many cafes the mod 
convenient, idly, In employing the unc- 
tion, or in giving a preparation of mercury 
internally, in fuch quantity as may mow 
its fenfible effects in the mouth. And, ^dly 
without carrying thefe effects to a greater 
length, in the continuing the employ- 
ment of mercury for feveral weeks, or 
till the fymptoms of the difeafe fhall have 
for fome time entirely difappeared. I fay 
nothing of the regimen proper and ne- 
ceffary for patients during the employment 
of mercury, becaufe I prefume it to be 
very well known. 

1787. Among 

* See the notes on Article 1770. 



440 P R A C T I C & 

1787. Among the other preparations 
of mercury, I believe the corrofive fub- 
limate has often been employed with ad- 
vantage : but I believe alfo, that it requires 
being continued for a longer time than is 
necefTary in the employment of other pre- 
parations in the manner above propofed ; 
and I fufpect it has often failed in making 
a cure, becaufe employed while perfons 
were at the fame time expofed to the free 
air. 



1788. Upon thefe points, and others re- 
lative to the adminiftration of mercury, 
and the cure of this difeafe, I might offer 
fome particular remarks : but I believe 
they are generally underftood ; and it is 
enough for me to fay here, that if prac- 
titioners will attend, and patients will 
fubmit to, the general rules given above, 
they will feldom fail of obtaining a 
certain and fpeedy cure of the difeafe. 

2 CHAP. 



OF PHYSIC. 



44* 



CHAP. III. 



©F 



S C U R V Y. 



1 7^9'TT , HIS difeafe appears fo fre- 

•*• quently, and the effects of 

it are fo often fatal in fleets and armies, 

that it has very properly engaged the par- 

Vol. IV. F f ticular 



44? PRACTICE 

ticular attention of phyficians. It is in>» 
deed furprifing that it had no foon^r at- 
tracted the fpecial notice both of ftatefmerj, 
and phyficians, fo as to have produced 
thofe meafures and regulations that might 
prevent the havock: which it fo often oc- 
cafipns. Within thefe laft fifty years, how- 
ever, it has been fo much attended to and 
ftudied, that we might fuppofe every cir- 
cumflance relating to it fo fully and exactly 
afcertained, as to render all further labour 
upon the fubject fuperfluous. This per«? 
haps may be true ; but it appears to. me, 
that there are (till feveral circumftances, 
regarding the difeafe not agreed upon a- 
mong phyficians, as well as different opi- 
nions formed, fome of which may have 
had a bad effect upon the practice : and 
this feems to me to be fo much the cafe, that 
I hope I fhall be excufed in endeavouring 
here to flate the facts as they appear to 
me from the beft authorities, and to offer 

remarks, 



O F P H Y S I C. 443 

remarks upon opinions which may influ- 
ence the practice in the prevention and 
cure of this difeafe. 

1790 With refpeel to the phenomena of 
the difeafe, they have now been fo fully 
obferved, and fo accurately defcribed, 
that there is no longer any doubt " in dif- 
cerning the difeafe when it is prefent, or 
in diftinguifhing it from almoft every o- 
ther ailment. In particular, it feems now 
to be fully determined, that there is one 
difeafe only, intitled to the appellation of 
Scurvy ; that it is the fame upon the land 
as upon the fea ; that it is the fame in all 
climates and feafons, as depending every 
where upon nearly the fame caufes ; and 
that it is not at all diverfified, either in 
its phenomena or its caufes, as had been 
imagined fome time ago. 

1 79 1 . The phenomena of fcurvy, there- 
F f 2 fore 



444 PRACTICE 

fore, are not to be defcribed here, as it 
has been fo fully and accurately done 
elfewhere ; and I fhall only endeavour to 
afcertain thofe facts with refpect to the 
prevention and cure of the difeafe which 
feem not yet to be exactly agreed upon. 
And, firft, with refpect to the antecedents 
that may be confidered as the remote 
caufes of the difeafe. 

1792. The mod remarkable circum- 
ftances amongft the antecedents of this 
difeafe is, that it has mod commonly 
happened to men living very much on 
faked meats ; and whether it ever arife 
in any other circumftances, is extremely 
doubtful. Thefe meats are often in a pu- 
trefcent flate ; and to the circumftance of 
the long continued ufe of animal food in 
a putrefcent and fomewhat indigeftible 
ftate, the difeafe has been efpecially attri- 
buted.— Whether the circumftances of 

the 



O F P H Y S I C. 445 

the meat's being faked, has any effect in 
producing the difeafe, otherwife than by- 
being rendered more indigestible, is a 
queftion that remains (till in difpute. 

1793. It feems to me, that the fait con- 
curs in producing the effect ; for there is 
hardly any inflance of the difeafe appear- 
ing unlefs where fait meats had been em- 
ployed, and fcarcely an example where 
the long continued ufe of thefe did not 
produce it : befides all which, there are 
fome inftances where, by avoiding falted 
meats, or by diminifhing the proportion 
of them in diet, while other circumstan- 
ces remained much the fame, the difeafe 
was prevented from appearing. Further, 
if it may be admitted, as an argument u- 
pon this Subject, I fhall hereafter endea- 
vour to mow, that the large ufe of fait has 
a tendency to aggravate and increafe the 
proximate caufe of fcurvy. 

F f 3 x 794- It 



446 PRACTICE 

1794* It mud, however be allowed, 
that the principal circumftance in caus- 
ing fcurvy, is the living very much and 
very long upon animal food, efpecially 
when in a putrefcent ft ate ; and the clear 
proof of this is, that a quantity of frefli 
vegetable food will always certainly pre- 
vent the difeafe. , 

1 795. While it has been held, that, in 
thofe circumftances in which fcurvy is 
produced, the animal food employed was 
efpecially hurtful by its being of difficult 
digeftion, this opinion has been attempt- 
ed to be confirmed, by obferving, that 
the reft of the food employed in the fame 
circumftances was alfo of difficult digef- 
tion. This is fuppofed to be efpecially 
the cafe of unfermented farinacea which 
fo commonly makes a part of the fea-diet. 
But I apprehend this opinion to be very 
ill-founded; for the unfermented farina- 

nacea. 



OF PHYSIC. 



447 



iiacea, which, are in a great proportion 
the food of infants, of women, and of 
the greater part of mankind, can hardly 
be fuppofed to be food of difficult digef. 
tion : and with refpect to the production 
of fcurvy, there are facts which mow, 
that unfermented farinacea, employed in 
large proportion, have had a confiderable 
effect in preventing the difeafe. 

1 796. It has been imagined, that a cer- 
tain impregnation of the air upon the fea 
had an effect in producing fcurvy* But 
it is altogether improbable : for the only 
impregnations which could be fufpected, 
are thole of inflammabje or mephitic air; 
and it is now well known that thefe im- 
pregnations are much lefs in the air upon 
the fea that in that upon the land; be>- 
Cdes, there are otherwife many proofs of 
the falubrity of the fea-air. If, therefore, 
fea-air have any effect in producing fcuf- 

e f 4 y r> 



PRACTICE 

vy, it muft be by its fenfible qualities of 
cold or moifture. 

1797. That cold has an effeft in fa- 
vouring the production of fcurvy, is ma- 
nifeft from hence, that the difeafe is more 
frequent and more confiderable in cold 
than in warm climates and feafons ; and 
that even warm cloathing has a confidera- 
ble effect in preventing it. 

1798. Moifture may in general have 
an effect in favouring the production of 
fcurvy, where that of the atmofphere in 
which men are placed is very confidera- 
ble : but the ordinary moifture of the fea- 
air is far from being fuch. Probably it 
is never confiderable, except in the cafe of 
unufual rains ; and even then it is per- 
haps by the application of moifture to the 
bodies of men in damp cloathing on- 
ly that it has any mare in the production 

of 



O F P H Y S I C. 449 

of fcurvy. At the fame time, I believe 
there is no inftance of either cold or moif- 
ture producing fcurvy, without the con" 
currence of the faulty fea-diet. 

1 799. Under thofe circumftances which 
produce fcurvy, it commonly feems to 
occur mod readily in the perfons who 
are the leaft exercifed ; and it is therefore 
probable, that confinement and want of 
exercife may have a great {hare in produ- 
cing the difeafe. 

1800. It appears that weaknefs," in 
whatever manner occafioned, is favour- 
able to the production of fcurvy. It is 
therefore probable, that unufual labour 
and fatigue may often have fome fhare 
in bringing it on : and upon the fame ac- 
count, it is probable, that fadnefs and 
defpondency may induce a weaknefs of 
the circulation ; and thereby, as has been 

remarked, 



4S° PRACTICE 

remarked, be favourable to the produc- 
tion of fcurvy. 

1 80 1. It has alfo been obferved, that 
perfons negligent in keeping their fkin 
clean by waihing and change of eloath- 
ing, are more liable than others to be af- 
fected with fcurvy. 

1802 Several of thefe caufes, now men- 
tioned, concurring together, feem to pro- 
duce fcurvy ; but there is no proper 
evidence that any one of them alone 
will produce it, or that all the others unit* 
ing together will do it, without the parti- 
cular concurrence of the fea diet. Alongft 
with this, however, feveral of the other 
circumftances mentioned have a great 
effect in producing it fooner, and in a 
more considerable degree, than would 
otherwife have happened from the diet 
alone. 

1803. From 



O F P H Y S I C. 451 

1803. From this view of the remote 
caufes, it will readily appear, that the 
prevention of the difeafe may in fome 
meafure depend upon the avoiding of 
thofe circumftances* which we have enu- 
merated as contributing to bring on the 
difeafe fooner than it would otherwife 
come on. At the fame time, the only 
effectual means will be, by avoiding the 
diet of faked meats ; at lead by lefTening 
the proportion of thefe, and ufing meat 
preferved otherwife than by fait ; by ufing 
in diet any kind of efculent vegetable 
matter that can be obtained ; and efpecial- 
ly, by uling vegetable matters the mod 
difpofed to acefcency, fuch as malt ; 
and by drinking a large quantity of pure 
water. 

1804. The cure of fcurvy feems now 

to be very well afcertainedj and when 

the neceffary means can be obtained, the 

n difeafe 



452 PRACTICE 

^ difeafe is commonly removed very quickly. 
The chief means is a food of frefh and 
fucculent vegetables, and thofe almoll 
of any kind that are at alt efculent. 
Thofe mod immediately effectual are the 
acid fruits, and, as being of the fame na- 
ture, all fort of fermented liquor. 

1805. The plants named alkalefcent % 
fuch as thofe of the garlic tribe and of the 
tetradynamise *, are alfo particularly ufe- 

ful 

* The plants of this clafs ought to be ufed in large 
quantities, and raw. The more a£tive fpecies are 
Horfe-radifh, Muftard, Water-crefs, Garden-crefs, 
Scurvy-grafs : The milder fpecies are, Radifties, 
Turnips, Cabbages, Cauli-fiowers, Brocoli, &c 

To the above lift, may be added fome other antifcor- 
butics of different claffes ; as Malt, Spinach, Beet, 
Carrots, Celery, Endive, Lettuce, Afparagus, the young 
fhoots-of Hops, Purflain, with feveral others. 



All 



OF PHYSIC. 455 

ful in the cure of this difeafe ; for not- 
withstanding their appellation, they in the 
firft part of their fermentation undergo an 
acefcency, and feem to contain a great 
deal of acefcent matter. At the fame time, 
they have generally in their compofition 
an acrid matter that readily paffes by 
urine, probably by perfpiration ; and by 
promoting both excretions, are ufeful in 
the difeafe. It is probable, that fome 
plants of the coniferous tribe, fuch as 
the fpruce fir, and others pofTeffed of a 
diuretic power, may likewife be of fome 
ufe. 

1806. It is fufEciently probable, that 
milk of every kind, and particularly its 

productions 



All thefe freih vegetables muft be eaten in large 
quantities ; they ought indeed to conftitute the patient's 
chief food, and his drink may be a freih infufion of 
Malt. 



454 PRACTICE 

productions whey and butter-milk, may 
prove a cure of the difeafe. 

1807. It has been common in this 
difeafe to employ the foflil acids ; but 
there is reafon to doubt if they be of 
any fervice, and it is certain they are not 
effeclual remedies. They can hardly be 
thrown, in in fuch quantity as to be ufeful 
antifeptics ; and as they do not , feem to 
enter into the composition of the animal 
fluids, and probably pafs off unchanged 
by the excretions, fo they can do little 
in changing the (late of the fluids. 

1808. The great debility which cdn- 
ftantly attends fcurvy, has naturally led 
phyficians to employ tonic and ftrength- 
ening medicines, particularly the Peruvian 
bark ; but the efficacy of if feems to me 
very doubtful. It is furprifing how foon 
the ufe of a vegetable diet reftores the 

ftrength. 



OF PHYSIC. 455 

ftrength of fcorbutic perfons j which, 
feems to {how that the preceding debility 
had depended upon the (late of the fluids ; 
and confequently, till the found ftate of 
thefe can be reftored, no tonic remedy 
can have much effect : but as the Pe- 
ruvian bark has little power in changing 
the ftate of the fluids, fo it can have little 
effect in fcurvy. 

1809. I fhall conclude my obfervations 
upon the medicines employed in fcurvy, 
with remarking, that the ufe of mercury 
is always manifeflly hurtful. 

1 8 10. After having obferved that both 
the prevention and cure of this difeafe 
are now very well known, it may feem 
unneceflary to enter -into much difcuflion 
concerning its proximate caufe : but as 
fuch difcuflion s can hardly be avoided, 
a,npl as falfe opinions may in fome 

meafure 



4 $6 PRACTICE ' 

meafure corrupt the practice, I fhall 
venture to fuggeft here what appears to 
me mod probable upon the fubject. 

1 8 1 1 . Notwithstanding what has been 
afferted by fome eminent perfons, I truft 
to the concurring teftimony of the moft 
part of the authors upon the fubjecl, 
that in fcurvy the fluids fuffer a con- 
siderable change. 

From thefe authors we learn, that in 
the blood drawn from the veins of per- 
fons labouring under the fcurvy, the 
craffamentum is different both in colour 
and confidence from what it is in healthy 
perfons ; and that at the fame time the 
ferum is commonly changed both in 
colour and tafte. The excretions alfo, in 
fcorbutic perfons, mow a change in the 
(late of the fluids. The breath is fetid ; 
the urine is always high-coloured, and 
2 more 



OF P H Y S I a 457 

more acrid than ufual : and if that acfid 
cxfudation from the feet, which Dr Hulme 
takes notice of, happens efpecially in fcor- 
butic perfons, it will be a remarkable 
proof to the fame purpofe. But however 
this may be, there is evidence enough 
that in fcurvy the natural ftate of the 
fluids is confiderably changed. Further, 
I apprehend it may be confidently pre- 
fumed from this, that the difeafe is 
brought on by a particular nourifhment 
introduced into the body, and is as cer- 
tainly cured by the taking in of a dif- 
ferent diet. In the latter cafe, the diet 
ufed has no other evident operation, than 
that of giving a particular ftate and con- 
dition to the fluids. 

1 8 12. Prefuming, therefore, that the 
difeafe depends upon a particular con- 
dition of the fluids of the body, the next 

Vol. IV. G g fubjed 



453 PRACTICE 

fubject of inquiry is, What that condition 
may be ? 

■ 
With this view, I muft obferve, that 
the animal oeconomy has a fingular power 
of changing acefcent aliments, in fuch 
a manner, as to render them much more 
difpofed to putrefaction : and although 
in a living flate, they hardly ever proceed 
to an : actually putrid ftate ; yet in man, 
whofe aliment is of a mixed kind, it is 
pretty certain, that if he were to live 
entirely upon animal food, • without a 
frequent fupply of vegetable aliment, his 
fluids would advance further towards 
putrefadlion than is confident with health. 
This advance towards putrefaction feems 
to confift in the production and evo- 
lution of a faline matter which did 
not appear in the vegetable aliment, and 
could not be produced or evolved in it, 
tut by carrying on its fermentation to a 

putrefactive 



OF PHYSIC. 459 

putrefactive ftate. That this faline flate 
is conftantly in fome meafure produced 
and evolved by -the animal procefs, ap- 
pears from this, that certain excretions 
of faline matter are conftantly made 
from the human body, and are there- 
fore prefumed neceffary to its health. 

From all this, it may be readily under- 
flood, how the continual ufe of animal 
food, efpecially when already in a putre- 
fcent flate, without a mixture of vege- 
table, may have the effect of carrying 
the animal procefs too far, and parti- 
cularly of producing and evolving a 
larger proportion of faline matter. That 
fuch a preternatural quantity of faline 
matter does exift in the blood of fcor- 
butic perfons, appears from the ftate of 
the fluids above mentioned. It will be 
a confirmation of all this to obferve, that 
every interruption of perfpiration, that is, 
G g 2 the 



460 "PRACTICE 

the retention of faline matter, contributes 

to the production of 'fcurvy ; and this 

interruption is efpecially owing to the 

application of cold, or to whatever elfe 

weakens the force of the circulation, fuch 

as the neglect or want of exercife, fatigue, 

and defpondency of the mind. It deferves 

indeed to be remarked here, that one of 

the firft effects of the fcurvy once induced, 

13 very foon to occafion a great debility 

of the fyflem, which occafions of courfe 

a more rapid progrefs of the difeafe. How 

the ftate of the fluids may induce fuch 

a debility is not well underflood ; but 

that it does depend upon fuch a ftate of 

the fluids, is rendered fufficiently pre- 

fumable, from what has been faid above 

'with regard to both the caufes and the 

cure of fcurvy. 

18 1 3. It is pomble that this debility 
may have a great fhare in producing feve- 

ral 



O F P H Y S I C. 461 

ral of the phenomena of fcurvy ; but a pre- 
ternaturaliy faline, and confequently dif- 
folved, ftate of the blood., will account for 
them with more probability ; and I do not 
think it hecefiary to perfons who are at all 
accuftomed to reafon upon the animal 
ceconomy, to explain this matter more ful- 
ly. I have only to add, that if my opini- 
on in fuppofing the proximate caufe of 
fcurvy to be a preternaturally faline ftate 
of the blood, be at all founded, it will be 
fufficiently obvious, that the throwing in- 
to the body along with the aliment an 
unufual quantity of fait, may have a great 
fhare in producing the difeafe. Even fup- 
pofing fuch fait to fufFer no change in the 
animal body, the effect of it may be consi- 
derable ; and this will be rendered ftill 
more probable, if it may be prefumed, that 
all neutral falts, confifting of a fixed alkali, 
are changed in the animal body into an' 
ammoniacal fait ; which I apprehend to be 
G g 3 tha 



462 PRACTICE 

that efpecially prevailing in fcurvy. If I 
be at all right in concluding, that meats, 
from being falted, contribute to the pro- 
duction of fcurvy, it will readily appear, 
how dangerous it may be to admit the con- 
clufion from another theory, that they are 
perfectly innocent. 

1814. Having thus endeavoured to ex- 
plain what relates to the cure of fcurvy in 
general, I judge it proper to leave to other 
authors, what relates to the management 
of thofe fymptoms which require a parti- 
cular treatment. 



CHAP. 



of PHYSia 463 



CHA P. IV. 



Qt 



JAUNDICE* 



1815. 1 Have Here patted over feveral 

,* of the titles in my nofology, 

becaufe they are difeafes not of this ifland. 

In thefe, therefore, I have no experience ; 

G g 4 and 



464 PRACTICE 

and without that, the compiling from 
other writers is always extremely fallaci- 
ous. For thefe reafons I omit them ; and 
fhall now only offer fome remarks upon 
the fubj eel of jaundice, the laft in order 
that I can poffibly introduce in my courfe 
of Lectures. 

18 16. The jaundice confifts in a yellow 
colour of the fkin over the whole body, 
and particularly of thcadnata of the eyes. 
This yellow colour may occur vfrom dif- 
ferent caufes ; bat in the jaundice, here- 
after to be more exactly charaderifed, I 
judge it to depend upon a quantity of 
bile prefent in the mafs of blood ; and 
which, thrown out upon the furface, 
gives its own proper colour to the fkin, 
and eyes.« 

18 17. That the difeafe depends upon 
this, we know particularly and certainly 

from 



O F P H Y S I C. 4 6 5 

from the caufes by which it is produced. 
In order to explain thefe, I mufl obferve, 
that bile does not exift in its proper form, 
in the mafs of blood, and cannot appear in 
this form till it has ,pafTed the fecretory 
organ of the liver. The bile therefore 
cannot appear in the mafs of blood, or 
upon the furface of the body, that is, 
produce jaundice from any interruption 
of its fecretion ; and accordingly, if jaun- 
dice does appear, it mufl be in confe- 
quence of the bile, after it had been 
fecerned, being again taken into the blood- 
vefTels. 

This may happen in two ways ; either 
by an interruption of its excretion, that 
is, of its paffage into the duodenum, 
which, by accumulating it in the biliary 
vefTels, may give occanon to its palling 
again into the blood- vefTels ; or it may 
pafs into thefe, by its being abforbed 
I from 



^66 PRACTICE 

from the alimentary canal, when it hap- 
pens to be accumulated there in an un-< 
ufual quantity. How far the latter 
caufe can take place, or in what circum- 
flances it does occur, I cannot clearly 
afcertain, and I apprehend that jaundice 
is feldom produced in that manner. 

1818. The former caufe of flopped ex- 
cretion may be underftood more clearly } 
and we have very certain proof of its be- 
ing the ordinary, and indeed almoft the 
univerfal caufe of this difeafe. Upon 
this fubjecY it will be obvious, that the 
interrupted excretion of the bile muft de- 
pend, upon an obftruclion of the dutlus 
communis choledochus; the mod common 
caufe of which is a biliary concretion 
formed in the gall-bladder, and from 
thence fallen down into the ductus com* 
munis, it being at the fame time of fuch a 
fize as not to pafs readily through the 

dutf 



OF PHYSIC 467 

duct into the duodenum. This duct may 
likewife be obftructed by a fpafmodic con- 
ftriclion affecting it : and fuch fpafm may 
happen, either in the duct itfelf, which 
we fuppofe to be contractile ; or in the 
duodenum preffing the fides of the dudl 
clofe together ; or, laftly, the duct may be 
obftructed by a tumour compremng it, 
and that arifing either in the duct itfelf, 
or in any of the neighbouring parts that 
are, or may come to be, contiguous to 
it. 

1 8 19. When fuch obftru&ion happens, 
the fecreted bile muft be accumulated in 
the biliary duds ; and from thence it 
may either be abforbed and carried by 
the lymphatics into the blood-veffels, or 
it may regurgitate in the duels themfelves, 
and pafs from them directly into the a- 
fcending cava. In either way, it comes 
to be diffufed in the mafs of blood j and 

from 



468 PRACTICE 

from thence may pafs by every exhalanc 
veffel, and produce' the difeafe in quef- 
tion. 

1820. I have thus fhortly explained the 
ordinary production of jaundice : but it 
mud be obferved farther, that it is at all 
times accompanied with certain other 
fymptoms, fuch as a whitenefs of the fa- 
ces alvin<e, which we readily account for 
from the abfence of bile in th,e inteftines ; 
and generally, alfo, with a certain confid- 
ence of the farces, the caufe of which is 
not fo eafy to explain. The difeafe is al- 
ways accompanied alfo with urine of a 
yellow colour, or at lead with urine that 
tinges a linen cloth with a yellow colour. 
Thefe are conftantly attending fymptoms ; 
and, though not always, yet there is com- 
monly, a* pain felt in the epigadrium, 
correfponding, as we fuppofe, to the feat 
of the du&us communis. This pain is 

often 



O F P H Y S I C 469 

often accompanied with, vomiting ; and 
even when the pain is not confiderable, 
a vomiting fometimes occurs. In fome 
cafes, when the pain is confiderable, the 
pulfe becomes frequent, full, and hard, 
and fome other fymptoms of pyrexia ap«- 
pear. 

1 82 1. When the jaundice is occafioned 
by tumours of the neighbouring parts 
comprefling the biliary duel:, I believe 
the difeafe can very feldom be cured. 
That luch is the caufe of jaundice, may 
with fome probability be fuppofed, when 
it has come on in confequence of other 
difeafes which had fubfifted long before, 
and more efpecially fuch as had been at- 
tended with fymptoms of obftruc'ted vif- 
cera. Even when tne jaundice has fub- 
fifted long without any intermiffion, and 
without any pain in the epigaftrium, an 
external compreflion is to be fufpected. 

1822. In 



470 PRACTICE 

1822. In fuch circumftances, I confider 
the difeafe as incurable ; and it is almofl: 
only when the difeafe is occafioned by bi- 
liary concretions obftrucling the biliary 
duct, that we may, commonly expedl 
relief, and that our art may contribute to 
the obtaining it. Such cafes may be ge- 
nerally known, by -the difeafe frequently 
difappearing and returning again ; by our 
finding, after the former accident, biliary 
concretions amongft the fasces ; and by 
the difeafe being frequently accompanied 
with pain of the epigaftrium, and with 
vomitings arifing from fuch pain. 

1823. In thefe cafes, we know of no 
certain and immediate means of expe- 
diting the pafTage of the biliary concre- 
tions. This is generally a work of time 
depending upon the gradual dilatation of 
the biliary duel ; and it is furprifing to 
obferve, from the fize of the ftones which 

fometimes 



OF PHYSIC. 471 

fometimes' pafs through, what dilatation 
the' duct will admit of. It proceeds, 
however, fafter or flower, upon different 
occafions ; and therefore the jaundice, af- 
ter a various duration, often ceafes fud- 
denly and fpontaneoufty. It is this which 
has given rife to the belief, that the jaun- 
dice has been cured by fuch a num- 
ber and fuch a variety of different reme- 
dies. Many of thefe, however, are per- 
fectly inert, and many others of them 
fuch as cannot be fuppofed to have any 
effect in expediting the paffage of a bilia- 
ry concretion. I fhall here, therefore, 
take no notice of the numerous remedies 
of jaundice mentioned by the writers on 
the Materia Medica, or even of thofe to be 
found in practical authors ; but fhall con- 
fine myfelf to the mention of thofe that 
may with probability be fuppofed to favour 
the paffage of the concretion, or remove 
the obftacles to it which may occur. 

1824. In 



472 PRACTICE 

1824. In the treatment of this difeafe, 
it is, in the firft place, to be attended to, 
that as the diftention of the biliary duel:, 
by a hard mafs that does not eafily pafs 
through it, may excite inflammation 
there ; fo in perfons of tolerable vigour, 
blood-letting may be an ufeful precau- 
tion ; and when much pain, together with 
any degree of pyrexia, occurs, it becomes 
an abfolutely neceffary remedy. In fome 
inflances of jaundice accompanied with 
thefe fymptoms, I have found the blood 
drawn covered with an inflammatory 
cruft as thick as in cafes of pneumonia. 

1825. There is no means of pufhing 
forward a biliary concretion that is more 
probable than the action of vomiting; 
which, by comprefling the whole abdomi- 
nal vifcera, and particularly the full and 
diftended gall-bladder and biliary vefTels, 
may contribute, fometimes gently enough, 

to 



O F P H Y S I C. 473 

to the dilatation of the biliary duct. Ac- 
cordingly vomiting has often been found 
ufeful for this purpofe : but at the fame 
time it is pofTible, that the force exerted in 
the act of vomiting may be too violent, 
and therefore gentle vomits ought only to 
be employed. And either when, by the 
long continuance of the jaundice, it may 
be fufpected that the fize of the concretion 
then pafTing is large ; or more efpecially, 
when pain attending the difeafe gives ap- 
prehenfion of inflammation, it may be 
prudent to avoid vomiting altogether. 

1826. It has been ufual in the jaundice 
to employ purgatives ; and it is poflible 
that the action of the inteflines may excite 
the action of the biliary ducts, and thus 
favour the expulfion of the biliary concre- 
tion; but this, I think, cannot be of much 
effect ; and the attempting it by the fre- 
quent ufe of purgatives, may otherwife 

Vol. IV. H h hurt 



474 PRACTICE 

* 
hurt the patient. For this reafon I appre- 
hend, that purgatives can never be pro- 
per, excepting when there is a flow and 
bound belly *. 

1827. J^s the relaxation of the fkin 
contributes to relax the whole fyftem, 
and particularly to relieve the conftriclion 
of fubjacent parts ; fo, when the jaundice 
is attended with pain, fomentations of 
the epigaftrium may be of fervice. 

1828. As 



* The good effects of purgatives, in removing biliary, 
"concretions in the du£l, are fufficiently apparent by 
daily experience. It is true indeed, that all purgatives 
have not this efFecT;, efpecially fuch as are of a gentle 
and now operation. The draftic purges, however, 
whofe action is both brilk, and of long continuance, 
have frequently been attended with good effects. Soms 
formulae of thefe brifk draftics have been defcribed in. 
the notes on article 1683. 



OF PHYSIC. 475 

1828. As. the folids of the living body- 
are very flexible and yielding ; fo it is 
probable, that biliary concretions would 
in many cafes find the biliary duel readily 
admit of fuch dilatation as to render 
their pafTage through it eafy, were it not 
that the diftention occalions a preterna- 
tural fpafmodic contraction of the parts 
below Upon this account, opium is 
often of great benefit in jaundice, and 
the benefit refulting from its ufe, proves 
fufficiently the truth of the theory upon 
which the ufing of it has been founded. 

1829. It were much to be wifhed, that 
a folvent of biliary concretions, which 
might be applied to them in the gall- 
bladder or biliary ducts, was difcovered? 
but none fuch, fo far as I know, has yet 
been found : and the employment of foap 
in this difeafe, I confider as a frivolous 
attempt. Dr White of York has found 
H h 2 a 



47 6 PRACTICE 

a folvent of biliary concretions when thefe 
are out of the body : but there is not 
the leaft probability that it could reach 
them while lodged within. 



INDEX 



INDEX 

To the FOUR VOLUMES. 

N. B. The Cyphers refer to the number of the Paragraphs. 

r a. 

Abscess, 250 

Abfcefs and uhers, the caufes of their different 
ftates, 254 

Acids employed in fever, 134 

refrigerant in fever, . 134 

A&ion of the heart and arteries, how increafed for 
preventing the recurrences of the paroxyfms of 



intermitting 


fever. 


> 






230 


Adynamia, 




, 






11 7 1 


Amenorrh<xa } 










995 




from 


retention. 




996" 








when < 


occurring, 


998 








fympt< 


)»S of, 


999 


• 




fib ■ 


5 


Amenorrha-a, 



478 INDEX. 



Amenorrhea, from retention, caufes of, 


ioco — 2 


cure of, 


1002 — 6 


from fupprefHon, 


996 


when occurring, 


1008 


fymptoms of, 


IOIO 


caufes of, ' 


1008 — 9 


cure of, 


IOII — 12 


Amentia, 


I59 8 


Anafarca, 


1668 


the character of, 


1668 


phenomena of 


1668—73 


cure ofj 


1674 — 96 


diftinguifhed from Leucophlegmatia, 1 669 


St Anthonys Fire. See Erythema. 




Antimonial emetics, employed in fevers, 


181 


their different kinds, 


181 


the adminiftration of them 


in fevers, 


183-186 


Antiphlogijlic Regimen, 


129 


how conducted, 


13© 


when employed in 


inter- 


mittent fevers, 


234 


Antispafmodics, employed in fevers, 


IJ2 — 187 


Aphtha, ■ 


733 


Apoplexy, 


1094 


diftinguifhed from palfy, 


1094 


diftinguifhed from fyncope, ' 


1094 




• Apoplexy, 



INDEX 479 

Apoplexy, predifponent caufes of lc 95 

exciting caufes of, 1098 — 115 — 16 

proximate caufe of, 1100— 21 

_ Serqfa, proximate caufe of 11*4 

prognoftic, 1122-23 

frequently ending in hemiple- 
gia, 1122 
prevention of, 11 24 
■whether fanguineor ferous, ftimulants 

hurtful in it, 1136—37 

from powers that deftroy the mobility 

of the nervous power, 1138 

cure of, 1131— 39 

Apyrexia, 2 4 

Af cites 7 I7°9 

charafterof, i7°9 

its various feat, 1 710 — n 

the phenomena of, . I7 I2_—I 3 

its particular feat difficulty afcertain- 

ed, I7 J 4 

the cure of, ^7 I J~ x 7 

AJlhma, 1373 

phenomena of, x 373 

exciting caufes of, *3° L 

proximate caufe of, I3°4 

diftinguifhed from other kinds of dyf- 

pncea, J 3°5 

H h 4 AJlhma, 



4Sd I N t) E X, 

Afthma, fometimes occasions phthifis pulmonalis, 1 386' 
frequently ends in hydrothorax, 1386 

feidom entirely cured> 1 387 

AJlrihgents employed in intermittent Fevers, 231 

joined with aromatics, employed in in- 
termittent fevers, 231; 
joined with bitters employed m inter- 
mittent feversy 23! 

Airahilis, I029 

Atrophia ab alvi fluxuy 1607 

debilium, * 6 °6 

inanitorum, 1607 

infantilis, 1605 

laftantium, ' 1605 

lateralis, - 1606— 11 

a leucorrhcea, 1607 

nervofa, 1606 

HUtricum, . - 1607 

aptyalifmo, 1607 

rachitica, 1605 

fenilis, 1606— 1 1 

Aura Epileptica, I3°5 

- B. 

.Bitters employed in intermittent fevers, 231 

joined with aftringents, employed in mtermit- 
tents, 231 

BUJlering, 



INDEX. 481 

Btijlering, its efFeds, 189—197 

its mode of operation in the cure of 

fevers, 190 — 194 

when to be employed in fevers, 195 

where to be applied in fevers, 1 96 

Jilood'letting, the employment of it in fevers, 138 — 143 
the circumftances directing its ufe in 
• fevers, 142 

the adminiftration of it in fevers, 143 
when employed in intermittent fe- 
vers, 234 



c. 



Cachexies, character of the clafs, 1599 

Cachexy, the term, how applied by authors, 1600 

Calculus Renalis, , 4 2 9 

Calx nitrata antimonii, its ufe in fevers, 183—185 

Canine madnefsy _ I 5 2 5 
the cure of, 1525— * 5 2 7 

Cardialgia, *4 2 7 

Carditis » 3^3 

of the chronic kind, 1 ^« 

Cams, *- I0 94 

Cataphord ' lb * 

Gatarrk, io 4 6 

Catarrh 



4& I N D E X. 



Catarrh, predifpofition to, 


1047 


fymptoms of, 


1048 


remote caufes of, 


1047 


proximate caufe of, 


I0 57 


cure of, 


1065 


produces phthifis, 


i°SS 


panes into pneumonia, 


,1054 


produces a peripneumonia notha, 


1056 


contagious 


1062 


Catarrhus Suffocative, 


376 


Chancre method of treating^ 


1781 


Chicken-pox, 


631 


how diltinguifbed from fmall-pox 


63 a 


Chincough, ■ 


140a 


contagious, 


ib 


frequently accompanied with fever, 1410 


phenomena, 


1404 


prognoftic in, 


1413 


cure of, 


1414 


Cblorqfis, 


998 


Cholera, ' 


■Hsi 


fymptoms of, 


1453-56 


remote caufes of, 


1458-60 


proximate caufes of, 


1454 


cure of, 


1462—64 


Chorea, ' . 


1 Ml 


phenomena^ 


1347— 53 




Chorea, 



N D E X. 


4*3 




*3J4 




1191 




1493 




88 




ib 




89 


ts on th'e human body, 


90—91 


s 


92 



Chorea, cure of 

Chronic weaknefs, 

Cceliaca, 

Cold, its operations, 

abfolute, 

relative, 

its general effei 

its morbid effects 

moderates the violence of reaction in fevers, 133 

its tonic power, how to be employed in fevers, 205 

Cold drink, an ufeful tonic in "fevers, 206 

the limitation of its ufe in fevers, 207 

air applied in fevers, 208 

water applied to the furface of the body in 



fevers, 


205— 2P9 


Colic, 


U3S 


the fymptoms of, 


M3J— 3 8 


proximate caufe of, 


M39 


cure of> 


1441 


Devonshire, 


i45i 


ef Poitou, 


*45 r 


cure of, 


1452 


Coma, 


1094 


Comata, 


3093 


Contagions, 


7 8 


their fuppofed variety, 


79 


2 


Cvnvulfutu, 



484 INDEX.' 

Qonvuljiom, 12 53 

Corpulency ; 1 02 1 

Cynanche, 3°° 

maligna, ,- 3 11 

parotidea, 33 » 

phargyngea, ^ 3J1 

tonjillaris, 301 

trachealis, , 3 1 " 

as affefting infants^ 332 — 329 

1 - the cure of it, 330 

CyfiitiSi 413 

D. 

Days, critical, in fevers, 107 — 124 

non-critical, 113 

Death, the caufes of, in general, 1 00 

the dire£l caufes of, ib 

the indirect caufes of, ' ib 

the caufes of it in fever, 1 01 

Debility in fevers, the fymptoms of, 104 

how obviated, 202 

Delirium in general explained, 1519 — 5° 

in fever, of two kinds, 45 

or infanity without fever, • 1550 - 57 

Diabetes, I5°4 

fymptoms of 1504 — 9 

Diabetes, 



I y D E X. 


485 


Diabetes, rem6te caufes of, 


1508 


proximate caufe of, 


1510— ia 


cure of, 


1513 


Diceta Aquea, 


157 


Diarrhoea, 


1465 


diftinguifhcd from dyfentery, 


1466 


diftinguifhed from cholera, 


1467 


' proximate caufe of, 


1468 


remote caufe of, 


I 47 I ~93 


cure of, i 


494—1503 


hiliofa, 


1480 


colliquative!. 


1501 


mucofa, ■ 


1488 


Diaihejis phlogijlica, 


62 — 247 


how removed, 


266 


Diluents, their ufe in fevers, 


154—158 


Difeafes, the diftinguifhing of them, how attained, 2 


the prevention of them, on what founded, 3 


the cure of them, on what founded, 


4 


Dropjies, 


l6 45 


in general, the caufe of them, 


1646 



of the breaft. SeeHydrothorax. 

of the lower belly. See A/cites. 

Dyfentery, . 1067 

contagious, ' . i°75 

remote caufes of, 1 07 2 

proximate caufe of, io 77 

Dyfei>tery t 



4 S6 I N D E ,X, 

Dyfettiery, cure of, lo8« 

ufe of mild cathartics to-be frequently 

repeated in it, ib 

rhubarb improper in it, ib 

Dyfenterta alba x ' 107,0 

Dyfmenorrhaea, 1014 

Dyfpepfia, H 9 o 

remote caufes of, i 119S 

proximate caufe of, JI 93 

' cure of, HiQX 

flatulence in it, cure of, 122 1 

heart-burn in it, cure of, ib 

pains of ftomach in it, cure of, ife 

vomiting in it, cure of* ib 

Byfpmtr, 1365 



Effluvia, human, 85 

from marflies, if, 

EmaciatiQ7ts 1600 

. caufes. of, > • i6qz — 18 

cure of, 161 9 

Emanfeo menjium, 098 

Emetics, fuited to the cure of fevers, 174 

their effects, 176 — 180 

a mean of removing fpafm, 170 

the adminiftration of in fevers, 17.5 

Emetics* 



INDEX. 4 8 7 



Emetics, their ufe in intermittent fevers, 


2 3°~*33 


Emprojlhotonos, 


1267 


Enteritis, 


404 


phlegmonic or erythematic, , 


404 


caufes of, 


407 


cure of, 


4^09 


Epilepfy, 


12S2 


phenomena of, 


1283 


proximate caufes of, 


1 284 


remote caufes of, 


1285 


predifponent caufes of, 


1310 


fympathic, 


*3 l5 


cure of, 


*S*1 


idiopathic, 


131S 


cure of, 


T 3*9 


Epifiaxis, 


806 


the caufes of it, 


808 


the various circumftances of, 


807 — 818 


the management and cure of, 


810-820 


Eryjipelas 


274 


of the face, 


708 


fymptoms of, 


705 — 708 


prognofis of, 


706 


proximate caufs of, 


697 


cure of, 


706—711 


. jphlegmonodes in different parts 


of 


the body, 


712 




Ertftpelasy 



1 N D E X. 



Eryjipelas, attending putrid fever, ^ r * 

Erythema, ■ , 274 

Exanthemata, c 8 c 

Exercife, ufeful in intermittent fevers, 331 



Fainting. See Syncope. w^i 
fatmty, I5 2 9 
ivar, a remote caufe of fever, 97 
Fever, g 
flriaiv fo called, the character of, 8-^-32 
phenomena of, , 8 
demote caufes of, are of a fedative na- 
ture, ' * ^6* 
proximate caufe of, « 
atony of the extreme veffels, a princi- 
pal circumflance in the proximate 
caufe of it, , 43—44 
fpafm, a principal part in the proximate 

caufe of it, . 40 

general doclrine of, 46 

the caufes of death in it, Id 

the prognofis of, QO 

indications of cure in, 126 

differences, r^ 

Fever, 



INDEX. 4 8 9 

Fever, continent, _ 28 

continued, 27 

inflammatory, 67 
miliary. See Miliary Fever. 

nervous, 67 

bilious, 71 
■fcarlet. See Scarlet Fever. 

putrid, 72 

named fynocha, . 67 

fynochus, 69 

typhus, 67 

he£Hc, 74 

intermittent, the paroxyfrn,s of, defcribed, .- 10 

the cold flage of, 1 1 

the hot flage of, ji 

the fweating flage of, u 

of a tertian periqd 25 

of a quartan period, 25 

of a quotidian period, 25 

• ' ♦ caufed by marfh effluvia, 84 

bile, not the caufe of it, 51 

cure of, 228 

its paroxyfms, how prevented, 229 

attended with phlogiflic diathe- 

fis, 234 

Vol. IV. I » f«Wj 



49° INDEX, 

Fever, intermittent, attended with congeftion in 

the abdominal vifcera, 234 

remittent, 26 

Fluxes, without fever. See Prqfluvia. 
Fluor Alius. See Leucorrhcea. 
Fomentation df the lower extremities, its ufe in 



J.CVC15, 


199 


Fomites of contagion, 


82 


FunEiions intellectual, diforders of 


1528—29 


G 


, 


Gangrene of inflamed parts, the caufe of, 


255—256 


marks of the tendency to, 


2 57 


marks of its having come on, 


z 57 


Gqfiritis % 


384 


phelegmonic or erythematic, 


3*5 


phlegmonic, the feat of 


385 


the fymptoms of 


385 


* the caufes of, 


387 


the cure of, 


323—397 


erythematic, how difcovered, 


400 


the feat of 


385 


the cure of, 

? 


401 


Gajlroiynia, 


- 1427 


Gleet, 


1769 


Gonorrhoea, 


1765 


phenomena of, 


1767—69 




Gonorrhea, 



INDEX. , 491 

Gonorrhoea, cure of, 1770—78 

Gout, the character of, 49a 

an hereditary difeafe, 500 

diftinguifhed from rheumatifiT), 5 2 ^ 

predifponent caufes of, 493 — 500 

occafional caufes of, 5 02 — 5° 5 

proximate caufe of, , 527 — 533 

not a morbific matter, 529 

Regular, defcribed, $06—518 

pathology of, 533 

cure of, 537—573 

no effe&ual Qr fafe remedy yet found 

for the cure of it, 539 

medicines employed for it. 556 

whether it can be radically cured, 540 
treatment in the intervals of pa- 
roxyfms, 54 2 
treatment in the time of paroxyfms, 56a 
regimen during the paroxyfms, 561 
external applications, how far 

fafe, 568—569 

blood-letting in the intervals of pa- 
roxyfms, 553 

, in the time of pa- 

roxfms, 563 

coftivenefs hurtful, 559 

I U Gout 



402 INDEX. 

Gout, Regular, laxatives to be employed, ctq 

effects of alkalines, 558 

effe&s of Portland powder 557 

Irregular, 5I g 

Atonic, 574-579 

pathology of, 534 

cure of, 580—582 

Retrocedent, 522 

pathology of, r * 535 

cure of, 580—582 

Mifplaced, - 523 

pathology of, ,536 

cure of 583— 584 

Tranflated, two particular cafes of, '525 



H. 



Hamateme/ts ? 1 01 7 

arterial and venous, 1027 

from obftrudled menftruation. 1020 

from fuppreffion of the' hemorrhoidal 

flux, 1025 

from compreflion of the vafa brevia by 

the fpleen, > 1027 

from obftru&ion of the liver, 1028 

H.07haturia 7 1033 

idiopathic, improbable, - 1033—34 

Hematuria, 



INDEX. 493 



Hematuria, calculofa, 


*°37 


cure of, 


1038 


violenta, 


1039 


from * fuppreflion of accuftomed dif- 




charges, 


1041 


. putrida, 


1043 


fpuria et lateritia, 


1044 


Hemiplegia, 


1 140 


caufes of 


1141 


frequently occasioned by apoplexy, 


1142 


frequently alternates with apoplexy, 


"44 


cure of, 


115a 


ftimulants, of ambiguous ufe in, 


1 160 


ftimulants external, in 


1 1 61 


Hxmoptyfis, 




the fymptoms of, ■ 838- 


-840 


the caufes of, 760 — 763 — 830 


-836 


how diftinguifhed from other fpittings 




of blood, 84] 


t— 4f 


cure of, 846 — 52 


Kaemorrhagia uteri. 


966 


Hxmorrbagy, 




a£Hve or paffive, 


735 


character of, 


736 


arterial, 


744 


I i 3 Hemorrhage t 



494 INDEX. 

Hemorrhage, venous, «6$ 

the caufes. of the different fpecies 
appearing at different periods of 
life, 75°- 773 

the general phenomena of, ^38 — 743 

the remote caufes of, 774 

cure of, 776 

■ whether to be attempted by 

art, ' 776—81 

prevention of the firft attacks, or of 

the recurrence of, 782—789 

treatment of when prefent, 789—805 

fymptomatic, 

Hcetnorrhoides ve/icce, \ 

Hamorrhoides, 

external and internal, 

phenomena of 

nature of the tumours, 

caufes of, 

acquire a connection with the fyftem, 

943-944. 

particularly with the ftomach, 946 

cure of, 947—965 

HepatirrJjcca, 1 4 8 1 

Hepatitis, ^ l2 

acute and chronic, ib. 

Hepatitis, 





1015 


- 


104a 




9 2 5 


9 2 S- 


-93* 




93 2 


933- 


-943 



INDEX. 49 5 

Hepatitis, acute, the fymptoms of, 413—415 
combined with pneumonic 

inflammation, 416 
remote caufes of it, 416 
feat of, 418 
various exit of pus pro- 
duced in, 421 
cure of 422 
chronic, the feat of, 418 
how difcovered, 423 
Hooping-cough. See Chincough. 1402 
Horror, impreffion of, employed in intermit- 
tent fevers, 231 
Human effluvia, the caufe of fever, 81 
body, its temperature, 88 
body has a power of generating heat, 88 
Hydrophobia, Z S 2 S 
Hydrothorax, 1 &97 
where feated, 1698 
fymptoms of, 1701 — 03 
often combined with univerfal 

dropfy, *7 4 
proximate caufe of, 1706 
cure of, 1703—08 
paracentelis in it, when pro- 
per, 1708 
Hypercatharjis, 1477 
I i 4 Hypochondria/is 



Hyjleria, 



A9 6 INDEX. 

Uypochondria/iS, . 1224 

phenomena of, 1222 

diftinguifhed from dyfpepfia, 1226 

proximate caufe of, I220 

cure of, I232 

treatment of the mind in, ' 1 244 

^4 

fymptoms of, , 1 5 15— 16 

, paroxyfm or fit defcribed, 151 5 -16 
rarely appears in males, 1 r , * 
how diftingmfhed from hypochon- 
dria^ 1518-19 
proximate caufe of, ! r 22 , 
analogy. between and epilepfy, « 1523 
cure of > 1524 
libidmofa, , I c 1 7 
Hyjleric difeafe. See Hyjleria. 

I. 



'James's powder, its ufe in 


fever, 


183 


Jaundice, 




1815-16 


caufes of, 




l8l6 — 21 


cure of, 




1823 — 29 


Icterus. See Jaundice. 






Iliac paffion. See Ileus. 







Ileus 



r 



INDEX. 497 

Ihus, 1437 

Impetigincs, *737 

character of the order, ib. 
Indlgejlion. See Dcfpepjla, 

Inflammation, the phenomena of, 235 

internal, the marks of, 236 

the ftate of the blood in, 237 

the proximate caufe of, 239 
not depending upon a lentor of 

the blood, 241 
fpafm the proximate caufe of, 243 — 248 

terminated by refolution, 249 

by fuppuration, 250 

by gangrene, 255 

by fcirrhus, 258 

, by effufion, 259 

by blifters, 260 

by exfudation, 261 

, the remote caufes of, 262 

the cure of in general, 264 

by refolution, r 264 
when tending to fuppu- 
ration, | 268 — 70 
when tending to gan- 

1*71 

grcne, *} 
lnfiammatien % 



INDEX. 



Inflammation, its general divifions, 


273 


more ftridtly cutaneous, 


*74 


of the bladder. See Cyjiitis. 




of the brain. See Phrenitis. 




of the heart. See Carditis. 




of the inteftines. See Enteritis. 




of the kidneys. See Nephritis. 




of the liver. See Hepatitis. 




of the lungs. See Pneumonia. 




of the pericardium. See Pericarditis. 




of the peritonaeum. See Peritonitis, 




of the fpleen. See Splenitis. 




of the ftomach. See Gajlritis. 




of the uterus, 


43 » 


Infanity, 


1 53S 


caufes of, 


1550-57 


of different fpecies, 


1 5S7 


. partial and general, difference of, 


1575 


Intemperance in drinking, a remote caufe of 




fever, 


91 


IntermiJJion of fever, ■ 


24 


Interval of fever, 


124 


Intumefcentiue, 


1620 


character of the prder of, 


1620 



K 

King's Evil. See Scrophula. 



Lettcophlegmatia 7 



INDEX. 499 

Leucophlegmatia, l66 9 

Leucorrhcea, 9 5 

.charader of, 9 S5 

appearance of the matter difcharged 

in, ' 987-991 

the caufes of, 9 88 

. the efFefts of, 99° 

the cure of, , 993 

Lethargus, * *°94 

Lientery, 

Loofenefs. See Diarrhcea. 

M 



1469 



Madnefs. See Mania. 

Canine. See Canine. 

Mania, x 55 8 

the fymptoms of, J 55° 

the remote caufes of, I S59~ 6l 

the treatment of, 15 62 — 74 

occurring in fanguine temperaments, 1376 

in fanguine temperaments cure of, 1577 

■** 1600 
Marcores, 

Marjh Effluvia, a caufe of fever, 8 4 

Meajles, 35 

the fymptoms of, 637-642 

the nature of, , 

the cure of, * J J 

MtnpSi 



S°o INDEX. 

Meajles, of a putrid kind, g,« 

Medicine, the inftitutions of. 

. 4 

Melana, x 

Melancholia, I C7 c 

how diftinguiflied from hypochon- 

driafis » 1587-88 

the chat-after of, 1582 — 89 

- the proximate caufe of, ijqo . 

the treatment of, 1 rg 2 „„ 

Melancholic temperament, 12 30 

Melancholy. See Melancholia. 

Menorrhagia, „^g 

aftive or paflive, j]j 

when a difeafe, 063 <• * 

efFe&s of, p 72 

proximate caufe of, ' 077 

remote caufes of, 0^8' 

cure of, g 8o 

Menfes, immoderate flow of them. See Menorrhagia. 

Metallic tonics, employed in intermittent fevers, ■ 231 

Salts, refrigerant, , jag 

Meteorifmus, jg,, 

Miafmatq, ,-g 

Miliary Fever, 

the general hiftory of 714 — 715 

•f two kinds, red and white, 716" 

Miliary 



I N D E X. 50* 

Miliary Fever, white, the fymptoms of, .7 1 7 - 7 1 9 

the cure of, 720 

Morbus caliacusy z 493 

Mucofus, I© 7° 

A%r, I02 9 

Nephritis, - 4*6 

the fymptoms of, "* 

the remote caufes of, 4 2 7 

the cure of, 43° 

Nervous difeafes. See Neurofes. 

Neurofes, °9 

Neutral /alts, diaphoretic in fevers, 159— 161 

refrigerant in fevers-, 13$ 

Nofology, Methodical, 3 

o 

Obejity, when a difeafe, 102 1 

Oneirodynia, 59 

. Ophthalmia, 2 7 8 

membranarum, lb 

its different degrees, 279-280 

its remote caufes, 1 " 

the cure of, 288-90 

tarn, or) ' 

the cure of, 288-290 

Opiates, employed, in the hot ftage of intermittent 

fevers, o: * 

in the interval of intermittent fevers, 3 3* 

Ofijlhotonos. See Tetanus. 

Palpitatino, 



503 I N D E X. 



Palpitation of the heart, 1 ZSS 

the phenomena of, 1 35S 

the caufes of, x 3j6 

the cure of, J 3^3 

Palfy, 1 1 40 

diftinguifhed from apoplexy, 1094 

caufes of, 11 41 

Paracentejis in afcites, when to be attempted, 1 7 1 7 

in hydrothorax, when proper, 1708 

Paraphrenias 343 

Par.oxyfm of intermittent fevers, the recurrence, 

how to be prevented, 229 

Pemphigus, 732 

Pericarditis , 3 S3 

Peripneumonia Notha, . 376 

fymptoms of, 379 

pathology of, 380 

the cure of, 381 — 382 

fome of the fymptoms explained, 350 

Peripneumony, ' 242 

Peritonitis, 384 

Peruvian bark, not a fpeciiic, 213 

its tonic power, 214 

when proper in fever, 215 

how moll efFe&ually employed, 216 

Peruvian 



INDEX. 



5°3 



Peruvian bark, the adminiftration of in intermittent 

fevers, 232 

the tonic chiefly employed in inter- 



mittent fevers, 


231 


Petechia, 


734 


Phlegmajice, 


235 


Phlegmon, 


274 


Phrenitis, 


291 


the character of, 


2 93 


the remote eaufes of, 


294 


the cure of, 


595—299 


Phrenfy. See Phrenitis*, 




Phyjic, the practice of, how taught, 


I 


the theory of, how to be employed, 


4 


Phyfconia, 


1718 


Phthifis Pulmonalis, the general character of, 


*S3 


always with an ulceration of the lungs. 


855 


the pus coughed up, how diftinguiflied from 


mucus, 


856 


accompanied with heclic fever, 


857 


the various eaufes of it, 


, 863 


from hsemoptyfis, 


864—865 


from pneumonia, ^ 


866—869 


from catarrh, 


870-873 


from afthma, 


875 


from tubercles, 


876-882 


- 


Phthifts 



5c 4 INDEX. 

Phthijis Puhnonalis, from calcareous matter in the 

lungs, ' 884 

if contagious, 886 



trom tubercles, iymptoms or, 




889 


its different duration, 




8 9 6 


the prognofis in, 




8 97 


the cure of, 


899- 


-9 2 4 


the treatment of, when arifing from 


tu- 




bercles, 


906- 


-921 


the palliation of fymptoms,. 


922- 


-924 


Plague, 






the general character of, 




665 


phenomena of, 




ib 


principal fymptoms of, 




667 


proximate caufe of, 




668 


prevention of, 


670- 


-685 


. cure of, 


686- 


-6 95 


Pleurify, 




•34i 


Pleurojihotonos. See "Tetanus. 




/ 


Pneumonia, or pneumonic inflammation, 




334 


general fymptoms of, 


33S- 


-339 


feat of, 


340 


344 


prognofis of, 


3Si- 


-360 


cure of, 




361 


the management of blood-letting 


in the 




cure of, 


362- 


-3 6 7 


the ufe of purgatives in, 




37° 


1 


Pimimon'ia, 



INDEX. 505 

Pneumonia , the ufe of emetics in, 371 

the ufe of blifters in, 37a 

the means of promoting expectoration in, 373 

the ufe of fweating in, 374 

the ufe of opiates in, 375 

Poly far cia, when a difeafe, . 162 1 

cure of, 1623—25 

Prqfluvia, 1045 

character of the clafs, ib 

Pulfe, the ftate of the, during the paroxyfm of an 

intermittent fever, 12 

Purging, its ufe in continued fevers, 144 

intermittent fevers, 234 

Pus, how produced, ' 250 

Putrefcency of the fluids in fever, the frmptoms 

of, 105 

the tendency to in fever, how to be 

be corrected, . 222 — 226 

Pylorus, fcirrhous. See Dyfpepjia, 

Pyrexia, " 

character of the clafr. 7 

orders of the clafs, ib 

Pyrofis, J 4 2 7 

fymptoms of, 1 43 I 

proximate caufe of, *433 

remote caufes of, *43* 

Vol. IV. K k Pyrofis, 



$z6 INDEX. 



ryrojis, cure or, 

Suecica of Sauyages, 


»434 
1428 


0. 




^uincy. See Cynanche. 

R. 
Rachitis, 


1719 


its origin, 


1720 


remote caufes o£, 


1721 — 23 


phenomena of, 


1724 


proximate caufe of, 


1725—28 


cure of, 


J729-36 


Rea&ion of the fyftem, 


59 


violent in fever, fymptoms of, 


103 


violence of, how moderated^ 


127 


Refrigerants, the ufe of them in fever. 


134 


Remedies, table of thofe employed in 


continued 


fevers, 


227 


RemiJJion of fever, 


26 



Refolution of inflammation, how produced; 249 

Refpiration, the changes, during the paroxyfm 

of an intermittent, 13 

Revolution, diurnal in the human body, 55 

Rheumatifm, acute or chronic, 433 

Acute, the remote caufes ofj 436 

the proximate caufe of, 445 — 460 

Rheumatifm^ 



INDEX. 5 o 7 

Rheumatifm, acute, the fymptoms of, 439 — 447 

cure of, 461—470 

Chronic, fymptoms of, 45© 

f how diftinguifhed from the acute, 451 

proximate caufe of, 47 % 

cure of, 473—476 

how ditfinguifhed from gout, 526 

Rickets. See Rachitis. 

Rofe. See Erythema. 



Scarlet Fever, 65 1 

the fymptoms of, < . 656 

different from cynanche maligna 651 — 655 

the cure of, 657 — 664 

Scrophula, 1 7 3 8 

v the phenomena of, 1738— 1749 

the proximate caufe of, 1750 

not contagious, *75 x 

not arifing from the lues venerea, 1752 

the cure of, I753~ 59 

Mefenterica, l6 ° 6 

Scurvy, J 7 8 9 

remote caufes of, 1792.-1802 

cure of, 1804—09 

proximate caufe of, 1811 — 14 

Sinapifms) 



5 o8 - INDEX. 

Sinapiftns, the effects of them, 197 

Skin, affettions of, See Impetigines. 

Small-pox, geneial character of, 587 

fymptoms of the diftinct kind, 589 

of the confluent kind, 590—593 

general differences between diftinct and 

confluent, 594 

caufes of thefe differences, 595 — 600 

prognofis in, 593 

cure of, 601 — 630 

inoculation of, 60 a 

the feveral practices of which N 
it confifts, 603 

the importance of the feveral 
practices belonging to, 604 — 615 
management of fmall-pox received by 
infection^. 616 — 630 

'Soda, 1427 

Spafm, internal, means of removing in fevers, 15a — 187 
the proximate caufe of inflamma- 
tion, 243 — '248 
Spafmodic affections without fever, 1251 
of the animal functions, 12-54 
of the vital functions, . x 35$ 
of the natural functions, - '1427 
Sphacelus, 25$ 

Splenitis, 



INDEX. 



S°9 



Splenitis, 425 

Stimulants, when to be employed in fevers, 217 

their ufe in intermittent fevers, 130 
Stom&ch, its confent with the veffels on the furface 

of the body, 44 
Sudorifics, arguments for their ufe in fevers, 

163 — 176 

"againft their ufe in fevers,, 164 

Suppuration of inflamed parts, the caufes of, 2$x 

the marks of a tendency to, 25 1 

formed, the marks of, _j 25 1 

Surface of the body, its confent with the ito- 

mach, 44 

Swellings, general. See Intumefc entice. ; 

adipofe, 1621: 

flatulent, 1626 
watery. See Lropjies. , 

Sweating, when hurtful in continued fevers, 165 
rules for the conduct of in continued 

fevers, 168 

ufe of in intermittent fevera 230 

Syncope, . 1171 

phenomena of, 1171 

• remote caufes of, 1*74 — J *78 

predifpofition to, 11 84 

cure of, 1 1 89 

Syncope r 



S io I N D i -"E X. 

Syncope, diftinguifhed from apoplexy, 1094 
Synocha. See Fever. .. 
Synochus. See Fever. ■ 

Siphylis, ' ' *7 6 ° 

originally from America, 1 761 

how propagated, 176a 

and gonorrhoea, how diftinguifhed, 1764 

the cure of, 1783-88 

T. 

Tahes a hydrope, *6o9 

a fanguifluxu, l6 ° 8 

• dorfalis, l6l ° 

glandularis, l6 ° 6 

mefentericar 1 ° 

nutricum, , l6 ° 8 

rachialgia, l6 ° 6 

fcrophulofa, ' lb 

'Tarter emetic, its ufe in fevers, 1 8 5 

Tetanus,' 12 S7 

remote caufes of, I2 "° 

cure of, 12 7° 

piffoleum Barbadenfe, or Barbado'es tar, in, 1280 

lateralis, I2(58 

Tonic medicines empolyed in continued fevers, 2" 

intermittent fevers, 231 

Tooth-ach, how far different from rheumatifm, 477—480 

fymptoms d£ 47 8 

Tooth-ach 






I N D E -X, 


5" 


J'ooth-acb, predifpofition to, . 


481 


remote caufes of, 


481—483 


proximate caufes of, 


4§3 


cure of, 


485— 49 l 


"Trifmus. See "Tetanus. 




nafcentium, 


1281 


Tuffis. See Catarrh. 




tympanites, the character of, 


1627 


the different fpecies of, 


1628 — 30 


intefhnalis, 


1628 


enterophyfodes, 


ib 


abdominalis, • 


ib 


afciticus, 


ib 


phenomena of, 


1632 


proximate caufe of, 


1635-36 


cure of, 


1637 44 


Typhus. See Fever. 




the fpecies of, 


70 


Vapours, or low fpirits. See Hypochondriajis . 


Venereal difeafe. See Siphyhs. 




Venery, excefs in, a remote caufe of fever, 


97 


Vefania, 




in general, 


1528 


Vis medicatrix naturce, 


35 


St Vitus's Dance. See Chorea. 




Vomiting of blood, See H^matemefis. 




effefts of, in continued fevers, 172 — 173 


' V 


Vomiting 



5 1 * 



£ N D E X. 



Vomiting, the ufe of in intermitting fevers, 236 — 34 

Urine bloody. See Hematuria. 

Urticaria, the hiftory, and treatment of, 730 

W. 

Water-brajh. See Pyrqfis. 
Whites. See Leucorrhcea. 

Warm-bathing, the effedts of in fever, 198 

the adminiflration of in fevers, 199 

the marks of the good effe£ts, 20s 

' Wine, the moft proper ftifnulant in fevers, 218 

its convenient ufe in fevers, 219 

■when hurtful or ufeful in fevers, 220 



THE END. 



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